Ask about the immediate period before the syncopal episode Position – lying, sitting, or standing? Activity – occurring at rest, during a change in position, during or after exercise, during or immediately after urination, defecation, coughing or swallowing? Triggers – crowded or stuffy environment, prolonged standing, after a meal, fear, severe pain in a body part, or turning the neck? Ask how you felt at the start of the syncopal episode – nausea, vomiting, abdominal discomfort, chills, sweating, smelling, neck and shoulder pain or blurred vision? Heart palpitations? Ask about the onset of syncope (usually requires a witness account) Mode of fall – heavy fall or just kneeling? Skin color – pale, purple or red? Duration of unconsciousness Respiratory status – snoring? Limb condition – muscle tonicity, clonicity, tonic clonicity or automatisms? Duration of limb movement? Biting of the tongue? Ask how you feel after the syncopal episode – nausea, vomiting, sweating, chills, confusion, muscle aches? Skin color – pale, purple? Is there any injury, chest pain? Are there palpitations? Urinary and fecal incontinence? Ask for background information Any family members with sudden death, arrhythmogenic heart disease, or syncope? History of past heart disease History of neurological disease – Parkinson’s disease, epilepsy, episodic sleeping disorder Metabolic disease – diabetes mellitus, etc. History of medication – antihypertensives, antianginals, antidepressants antiarrhythmics, diuretics, or drugs that prolong the QT-T interval. Patients with recurrent syncope, regarding the time of the first episode, the interval between episodes and the frequency of episodes The above initial evaluation can generally reveal some obvious arrhythmias such as long QT interval syndrome, pre-excitation syndrome, etc. It can also clearly diagnose some reflex syncope, syncope due to upright hypotension, syncope due to some postural tachycardia syndromes, etc. Some syncope due to medications can also be diagnosed by Some syncope caused by drugs can also be diagnosed by history taking. Furthermore, the physical examination and electrocardiogram can reveal some clues of syncope causing diseases such as hypertrophic cardiomyopathy with heart murmur and abnormal electrocardiogram, and cyanosis and heart murmur on physical examination suggesting cyanotic congenital heart disease, etc. If the above initial evaluation does not suggest a diagnosis, then further evaluation can be performed for syncope of unknown origin.