In the evaluation of patients with syncope, the critical first step is a detailed medical history. A diagnostic strategy based on initial evaluation is warranted. The importance of the initial evaluation goes well beyond its capability to make a diagnosis as it determines the most appropriate subsequent diagnostic pathways and risk evaluation. According to the Guidelines on Syncope of the European Society of Cardiology (ESC)1,2 the “initial evaluation” of a patient presenting with syncope consists of taking a careful history, and a physical examination, including orthostatic blood pressure measurements and standard electrocardiogram (ECG). Three key questions should be addressed during the initial evaluation: Table 1 provides the clinical classification of the principal known causes of syncope proposed by the Task Force on Syncope of the ESC.1,2 The subdivision of syncope is based on pathophysiology as follows: View this table: Table 1 Causes of syncope