It is sobering to consider the vast spectrum of causes of syncope. It is fortunate, however, that 30% to 74% of cases are assigned the correct cause on the basis of a thorough history and physical examination. However, a shotgun approach to evaluation is costly and may expose the patient to unnecessary risk and concern. Examples of diagnostic excess are routine CT scanning of the head and routine EEG, both of which have a very low yield on routine use. These procedures should only be used if they are necessary to answer questions raised by the initial evaluation.