In a patient with recurrent unexplained syncope, a case of tilt-induced vasovagal syncope is presented. In a 60 degrees head-up tilt table test, the patient developed complete AV-block and hypotension with loss of postural tonus. After treatment with a B-receptor blocker the head-up tilt table test was better tolerated. The importance of instructions to recognize prodromic symptoms to prevent syncope is underlined. No obvious benefits of medical therapy have been found.