eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2020-09-25 8 12 518 521 10.12691/ajmcr-8-12-24 AJMCR202081224 article Harshith Priyan Chandrakumar 1 Karishma Patwa 2 Yuvraj Singh Chowdhury 2 Mrinali Shetty 3 Ridhima Goel 3 Jennifer Otey 3 Ahmed Awwad 3 Moro O. Salifu 3 Samy I. McFarlane smcfarlane@downstate.edu 3 Department of Internal Medicine, State University of New York- Downstate Health Science University, Brooklyn, NY 1203 Division of Cardiovascular Medicine, State University of New York- Downstate Health Science University, Brooklyn, NY 1203 Division of Cardiovascular Medicine, University of Chicago (NorthShore), Evanston, IL 60201 Coronary artery anomalies are congenital defects which are found incidentally or after cardiac events. While these are rare abnormalities with the majority of patients remain asymptomatic and largely undiagnosed, it remains to be a major cause of sudden cardiac death (SCD). Anomalous origin of left coronary artery (ALCA) from the opposite right aortic sinus is extremely rare with less than 100 cases reported to-date. These patients are at increased risk for significant cardiac events, including SCD. In this report, we present a 48-year-old man with hypertension and marijuana use who was admitted initially with multi-lobar pneumonia and acute kidney injury, developed respiratory failure and sustained ST elevation myocardial infarction (STEMI). Coronary angiography demonstrated anomalous origin of all three main coronary arteries arising from right aortic sinus. In this report we also discuss the genesis of this rare and potentially fatal congenital abnormality and we highlight the diagnostic and management strategies available to-date. http://pubs.sciepub.com/ajmcr/8/12/24/ajmcr-8-12-24.pdf anomalous origin of coronary arteries anomalous left coronary artery right coronary artery st- elevation myocardial infarction