Syncope is a common, sometimes life-threatening condition. Of particular importance are the initial basic diagnostics, the differentiation of syncope-like diseases, and the risk assessment regarding possible life-threatening causes, especially arrhythmias. This determines the specific further diagnostics and therapy. In the absence of high-risk criteria, the most important diagnostic examinations are as follows: the tilt table test for suspected reflex syncope (if not already clarified by history) or the longer-term rhythm monitoring using an implantable loop recorder (ILR) in case of a justified suspicion of an arrhythmogenic syncope (unexplained, recurrent syncope without prodromes). By means of echocardiography and possibly ischemia diagnostics, it should be clarified whether a heart disease is present. Therapy options for reflex syncope include patient information, isometric maneuvers, standing training, increased fluid intake, rarely drug therapy, and extremely rarely pacemaker therapy.