Prevalence of the coronary artery anomaly is approximately 1% of the population who undergo coronary angiography. The anomalous origin of the right coronary artery (RCA) as a branch of the left anterior descending artery (LAD) is a very rare variation of single coronary artery. The anatomic variation has no clinical significance. However, some patterns of congenital coronary artery anomalies can cause clinical manifestations of myocardial ischemia, reducing myocardial perfusion. We report on a case of a 78-year-old man who had anomalous RCA arising from the proximal part of the LAD, which probably caused chest pain.