A 70-year-old previously healthy man presents with episodes of presyncope - he feels light headed and as though he is about to pass out. On your examination, his vital signs are normal with no evidence of postural hypotension. Examination of his head and neck, cardiovascular and neurological systems are unremarkable. You advise him to keep a diary on the circumstances surrounding his episodes. Two weeks later he is brought to the ER following a syncopal episode that occurred while shaving in his bathroom.
What is your diagnosis, what studies would you order to confirm your diagnosis, and what treatment, if any, do you recommend?
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