Introduction: Sometimes, an acute non-cardiac thoracic pain can have quality, location and radiation area quite similar to those of the ischemic pain. Early recognition of such non-thoracic causes of acute chest pain may avoid unnecessary use of expensive diagnostic means (conventional angiography, CT angiography). Methods: A female patient, aged 53, without major coronary risk factors, was admitted for a 24 hours history of squeezing and burning pain over the left anterior thoracic area, radiated to the inner side of the left arm and then interscapular, accompanied by breathlessness and palpitations and initially labeled as acute coronary syndrome. Serial electrocardiograms were normal during pain, as well as the echocardiogram, no elevation of the cardiac biomarkers was seen and the antianginal medication had no effect. One day later, the patient developed the characteristic rash for herpes zoster with a distribution over the first left thoracic dermatome, explaining patient’s symptoms. Conclusions: Although the coronary origin should always be sought for amidst the possible causes of an acute chest pain, some non-coronary causes are able to mimic the clinical picture of angina pectoris. Early recognition of such causes allows faster specific treatment and therefore spares expensive and unnecessary diagnostic tools.