Chest pain and palpitations caused a 57-year-old female with Hashimoto disease to visit our outpatient clinic. Physical examination, laboratory testing and ECG showed no abnormalities. Given the 13-beat non-sustained ventricular tachycardia on Holter monitoring and persistent chest pain, cardiac catheterisation was performed. This showed the origin of the left anterior descending artery (LAD) to be anomalous, coming from the right coronary cusp (Fig. 1a). Coronary computed tomography showed no overt external compression (Fig. 1b).