We report a case of ST elevation myocardial infarction (STEMI) during head-up tilt testing (HUTT). A 54-year-old man was admitted to our emergency department after four episodes of syncope. Treadmill test and electrophysiological study were normal. During passive HUTT, the patient had inferolateral ST elevation. Coronary angiography showed two severe lesions in the right coronary artery and circumflex artery.