Abstract
Coronary artery anomalies are a diverse group of congenital disorders, with a reported incidence of 0.6 – 1.3%. Congenital absence of the LCX is an extremely rare anomaly, with a frequency of only 0.003% in all patients who undergo coronary angiography. Here, we present a case of 76-year-old female who had an episode of chest pain while she was hospitalized for management of small bowel obstruction with elevated troponin and coronary angiogram showed super-dominant right coronary artery without any obstructive disease.