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We report the case of a 71-year-old woman with medical history of hypertension; she attends the hospital because of oppressive retrosternal pain and clinical data suggestive of an acute coronary syndrome. During treatment, the incidental finding of anomalous coronary arteries originating from the right Valsalva sinus is found. This congenital anomaly is very unusual and there is a reported prevalence of 0.0024% in the general population. Most patients are asymptomatic, although an association with ischemic symptoms has been reported. In symptomatic patients, an individualized approach must be given because there is no standard treatment due to the low prevalence of this anomaly.