The physical examination includes complete cardiovascular (heart sounds, murmurs, rhythm, and the character of pulses), neurologic, and pulmonary examinations. Abnormalities found on examination warrant further workup. Tests should be directed by the history: a classic story for vasovagal syncope with a normal physical examination requires no further testing. Palpitations or exertional syncope require ECG evaluation for potential arrhythmias. Sudden collapse, especially during exercise suggests structural abnormalities, particularly when associated with a murmur on physical examination. ECG, chest radiography, and echocardiography should be considered in this setting. Syncope associated with chest pain may require cardiac troponins as part of the evaluation to rule out ischemic heart disease (eg, aberrant left coronary artery). Electrolytes, thyroid studies, and urine pregnancy testing or drug screen should be considered in the appropriate clinical setting.