Diagnostic evaluation and management of syncope

Syncope is a common and important clinical problem that occurs in up to 30% of adults and accounts for up to 6% of general hospital admissions. Syncope of cardiovascular origin is particularly important to identify as it is associated with a high risk of sudden cardiac death. A complete history and physical examination may suggest a diagnosis in the majority of patients, but additional evaluation is often required. Electrophysiologic testing is of highest diagnostic yield in patients with structural heart disease. Negative electrophysiology test results are also of importance as they predict a very low incidence of sudden cardiac death during follow-up. Tilt-table testing is a recently developed tool that allows a diagnosis of vasopressor syncope to be established despite an atypical clinical history. Tilt-table testing can also be used to guide therapy.