Patients presenting with acute coronary syndromes are classically described as having chest
pressure with radiation to the left arm. However, pain can be referred to multiple sites including
the face, the neck, the abdomen and the contra-lateral arm. We present a case of sudden
bilateral ear pain as the sole presentation of acute coronary syndrome in an elderly man. The
importance of recognizing these atypical presentations is vital, as outcomes may be worsened
as appropriate therapy may be delayed or misdirected. (Cardiol J 2010; 17, 6: 623-624
