Syncope is a syndrome characterized by a relatively sudden, temporary, and self-terminating loss of consciousness. Possible causes of syncope are numerous, but the unifying feature is the underlying pathophysiology; specifically, a temporary inadequacy of cerebral nutrient flow most often due to a fall in systemic arterial pressure. Delineating the underlying etiology of syncope in a given patient is often challenging but is important, since syncope, while even if often relatively benign from a mortality perspective, tends to recur. An inaccurate diagnosis and an incorrect treatment leave the affected individual at risk of physical injury, diminished quality-of-life, and possible restriction from employment or avocation; furthermore, a life-threatening problem may be missed (e.g., cardiac syncope, channelopathies). In the majority of patients presenting with syncope a careful history, physical examination, ECG, and possibly an echocardiogram are sufficient to establish the diagnosis with substantial certainty. The most common example is when the history is indicative of one of the neurally mediated reflex faints (i.e., vasovagal, carotid sinus, or situational syncope). However, although the medical history is the physician’s most valuable tool in the initial syncope assessment, its value is undermined if it is inadequate in detail and/or the patient cannot provide a reliable description of events (e.g., children, patients with cognitive impairment). In these latter cases or if the initial evaluation is inconclusive, selective application of further diagnostic tests (e.g., ambulatory ECG monitoring, head-up tilt test) is needed. As a rule assessment should be lead by physicians who take a particular interest in the syncope evaluation. In this regard, more widespread development of syncope management units (SMUs) and rapid access syncope/falls clinics is strongly encouraged; together, they have been shown to reduce both hospital costs and number of undiagnosed cases.