A 40-year-old woman with no risk factors for ischaemic heart disease presented as an emergency with chest pain and anterior ST elevation on her ECG. She had no other comorbidities, had no history of pregnancy and was not taking any medications. She was transferred for emergency percutaneous intervention (PCI). On engaging the right coronary artery, there was catheter induced spasm at the ostium. Left coronary angiography revealed an abnormal appearance of the left anterior descending artery (LAD) (figure 1A). IVUS was used to interrogate the vessel (figure 1B).