[Syncopes: evaluation and management]

The optimal management of patients presenting with syncope depends on the aetiology of symptoms. The first step is to differentiate patients without heart disease from others. The clinical history and the examination are the most useful, and in almost half the cases, suggest a presumptive diagnostic. In patients without heart disease, tilt test and autonomic nervous system testing are the investigations with the greatest yield. In patients with heart disease, hemodynamic and electrophysiologic studies are frequently needed. Neurologic investigation are rarely useful and only needed if syncope is associated with focal neurologic manifestations. In some cases implantable ECG loop recorder has proved to be useful. In most of the patients, correlation of symptoms and results of investigations results in appropriate therapeutic strategy.