Introduction: Carbon monoxide (CO) poisoning continues to be challenging in diagnosis and management. The complications related to CO poisoning are variable and unpredictable. Case Presentation: We present the case of a 73-year-old woman who was involved in an indoor fire. Although she was asymptomatic and had a low CO level, she developed an acute coronary syndrome. The condition of the patient recovered remarkably after treatment with oxygen supplementation and anti-ischemic drugs. Conclusion: This case indicates that an acute coronary syndrome could represent a complication of CO poisoning even in asymptomatic patients with low levels of COHb.