Coronary artery anomalies are congenital and relatively uncommon. Anomalous origin of the left circumflex artery from the right is a relatively common congenital coronary variant and is usually considered benign in itself. The presence of an anomalous coronary artery may pose challenges in engaging the anomalous vessel, and prompt recognition of an anomalous coronary artery is important to allow for appropriate coronary interventions. Here, we describe the case of a patient who presented with cocaine-induced acute ST-segment elevation myocardial infarction and was incidentally noted to have an anomalous left circumflex coronary artery arising from the right coronary cusp with a relatively uncommon variant of the anomalous origin. We believe that this case in itself is rare and discusses the approach to anomalous coronaries in an acute coronary syndrome presentation which is unique and rare in the existing literature regarding coronary anomalies.