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Fish bone as a foreign body is the most common food-associated foreign body in Asians as compared to meat impaction in the Western population, and the most common site is upper esophagus. The impaction of fish bones in the gastrointestinal tract during ingestion is a common complaint and can mimic acute coronary syndrome (ACS). A 45-year-old man presented to our emergency department with acute-onset retrosternal pain. Electrocardiogram, Troponin I, and two-dimensional-echocardiography were normal. Computed tomography of the chest showed a lodged fish bone tenting the upper esophagus, which was removed endoscopically. He was discharged on the 3rd day of the procedure. This case showed an unusual cause of acute chest pain which was initially suspected as ACS based on American College of Cardiology/American Heart Association guidelines. This case highlights the importance of thorough history taking and a need for high level of alertness in reaching the correct diagnosis.