Congenital coronary artery anomalies are a rare cause of major cardiovascular events in adolescents who practise sports activities. Therefore, symptoms suggestive of cardiac ischaemia should always be carefully considered and subjects should undergo a complete cardiovascular assessment. We describe the case of a young non-competitive athlete, referring episodes of exertional chest pain and syncope, in whom multiple imaging techniques allowed the diagnosis of intramural course of the left anterior descending coronary artery.