Abstract: Although the left coronary artery originating from the right sinus of Valsalva is a rare anomaly, sudden death or myocardial ischemia may be observed in relation with this anomaly. We described a 78-year-old female patient with atherosclerotic lesions in the anomalous left main and anterior descending artery originating from the right sinus of Valsalva who admitted with post-infarction effort angina.