The card is an absolute monster in terms of size. These pics are a comparison between my previous 8800GTX to the new card. Granted the angles are terrible and the case is full of dust with no cable management whatsoever but I wasn't taking pictures to highlight my terrible maintenance or photographic abilities
You can see clearly that the 4870x2 is both longer and wider in comparison to the 8800GTX.
As previously mentioned it covers two slots but realistically you won't be able to fit anything in the third because it will significantly reduce airflow to the graphics card and on top of that it would have to be wafer thin to fit in the slot under it. Fortunately I don't have anything in the way of PCI cards besides a SATA card right at the bottom so it didn't cause me any problems. If you have a lot of PCI cards though this could be potentially one to steer clear of.
Noise wise the card isn't quiet. When idle it doesn't make much noise, same sort of volume as most non silent case fans do. When it is under load though it becomes pretty noisy. I've not had a card as noisy as this one before but considering it has three small fans and the card runs hot anyway it's not a surprise it would be pretty noisy. Fortunately though if you play games with a headset, like I assume most people would tend to do nowadays, then you are unlikely to be disturbed by the volume of it. Of course you always have the option to drop the fan speed on the card if you want to, but by default it can get fairly noisy. On a negative note my card seems to have the dreaded capacitor whine but it only rears it's ugly head in game menus from what I can tell. As soon as actually into a game it seems to go away so it hasn't really bothered me other than to mention it exists.
Temperatures are pretty good considering how hot the stock cooled models go. So far I've only managed to get the card to go up to low 70's celcius running Crysis, I don't have any GPU testing programs but I guess under maximum load it would go a little higher than that. It idles at 43/44 in my case which has pretty good airflow, especially to the GPU (Silverstone TJ09). Due to the relatively low temps I would think there would be no issues overclocking this card although I haven't tried so I've no idea if they clock well at all. If I'm honest I can't say I really need the card to be any faster anyway!
One thing I have found which I wasn't expecting is that it runs my TV (which I use as a second screen) much much better than my previous card did. I found my previous card would slightly crop the screen despite being at the correct resolution and was never quite as clear as I would have liked for reading any kind of text. No such issues with the new card, no cropping at all and it's crystal clear straight off the bat.
Lastly, and obviously most importantly, is the performance of this card. It is unbelievably powerful in comparison to my previous card. It wipes the floor with every single game I try. Even Crysis runs smooth as butter with all settings high and 4x AA but I think that Crysis has issues with the ATI drivers as it doesn't seem like as much of an improvement over my previous card as every other game I've tried. This card makes any source engine game look like a joke, Left 4 Dead with everything maxed out at 1920x1200 FPS never drops below 70. That's with 8xAA/16xAF, I honestly wasn't expecting it to be so powerful that I literally can't find anything it won't play maxed out with ease(with exception to Crysis due to assumed driver issues combined with it being coded for nvidia from the start). I also tried The Sims 3 on this card and it is massively better running on this card than it was on my 8800GTX. Everything maxed out I never get any kind of slowdown at all whereas my GTX seemed to struggle when trying to scroll around the map zoomed out.
All in all I'm very pleased with this card, it does everything I expected of it and more. It's a monster card with matching performance. The only con the card has is the noise of it which being impartial is probably going to be fairly annoying for some people. For myself it doesn't really bother me, I wear a headset to game and that won't be changing anytime soon if ever. When you consider that on top of the fact the card is fairly noisy it's still much quieter than the stock cooler then it should be an easy decision which version to go for.