Explaining the Unexplained Causes of Syncope

Determining the cause of recurrent unexplained syncope remains a clinical challenge and a permanent quest. Guidelines and multiple studies emphasize that a clear deductive method based on a thorough interrogation and examination can usually disclose the etiology of syncope in the majority of cases (2). Nonetheless, in daily clinical practice, applying a simple comprehensive diagnostic approach to the patient that manifests with syncope remains an unmet goal. From a practical perspective, the main goals when evaluating the patient with recurrent syncope are simple: 1) establish a diagnosis and prognosis; and 2) implement therapy. As simple as this may sound, the reality is that in clinical practice, the strategy for evaluation of the patient with recurrent syncope is inconsistent and usually leads to multiple, low-yield, costly, and unnecessary testing and unwarranted hospital admissions (2).