Subclavian steal syndrome is caused by a proximal stenosis of the subclavian artery that results in a reversal of blood flow. It can cause symptoms in the brain, heart, and upper extremity due to reduced blood flow. Physical examination may reveal blood pressure differences between arms or bruits. Diagnosis is supported by imaging tests like ultrasound and angiography. Treatment involves medications for asymptomatic cases, while more severe symptomatic cases may require stenting or surgery to restore blood flow.