Patients with hypertrophic cardiomyopathy may experience syncope. This chapter reviews three etiologies of syncope: arrhythmogenic (bradycardia and tachycardia), structural (left ventricular outflow tract obstruction and mitral valvular abnormalities), and neurocardiogenic (autonomic dysfunction). An approach to the evaluation of syncope is presented in terms of its etiology, diagnosis, and current guideline-based treatments.