There are significant gaps in our understanding of the pathophysiology, diagnosis and treatment of NMS (neurally mediated syncope). Contributions in this area will be welcomed by patients and physicians taking care of them alike. In this issue of Clinical Science, Simek and co-workers report a novel non-invasive physiological measurement that does not require head-up tilt to diagnose NMS. However, validation studies applied to an unselected patient population are needed before we can judge how useful this test will be in the diagnosis of NMS.