Current concepts in the evaluation and management of syncope.

Syncope is a very common presentation with a wide differential diagnosis and equally wide prognostic implications. Recent work has highlighted the importance of an accurate history and physical examination as the basis of diagnosis, prognosis, and treatment. Several centers have evaluated the role of structured histories and comprehensive syncope evaluation guidelines and units in managing syncope. Although these do provide comprehensive care, whether they improve overall outcome and reduce costs is far from clear. This is partly because there are few effective treatments for the major cause of fainting, vasovagal syncope. Recent randomized trials have highlighted the roles of physical counterpressure maneuvers and midodrine and the limitations of treatment with beta blockers and permanent cardiac pacing.