Syncope is loss of consciousness due to reduced blood pressure to the heart, hence as soon as falls down recovers. 

1. IS IT VASOVAGAL?

1. What stimulates the vagal? Visceral organ: Cough, micturition, defeacation 
2. Carotid bodies eg boxers, turn head to side if wearing tight neck collar
3. Sight of blood
4. CF- Situational reproducible, prodrome. Classical hence no need for table-tilt test
5. Rx- BB

ORTHOSTATIC

• Orthostasis: BP changes by 20/10 and HR by 15 on positional change when getting from lying to standing position or gets so weak cannot finish the test
• When stands up gets the problem
• Fluid challenge. If resolves, confirms volume loss (ie diarrhea, diabetes, haemorrhage etc). If not look for ANS dx ie DM, Parkinson's, age

CARDIOGENIC ie HCM/AS, arrythmia

• Exertional syncope= HCM/AS. Dx Echo
• Arrythmias: No prodrome and paroxismal hence ECG missses. 24-Holter or Event recorder

NEUROGENIC (posterior circulation - extremely rate)

1. Non-prodromic TLOC (sudden without prodrome, just like arrythmias but with focal neurologic deficit)