A 40-year-old male presented with stable angina of 5 months duration with normal resting electrocardiography and echocardiography. Antianginal treatment was started but he remained symptomatic despite optimal medical therapy. His clinical examination was unremarkable. Invasive coronary angiography revealed anomalous origin of left coronary artery arising from right sinus of Valsalva traversing anterior to right ventricle outflow tract (Figure 1, Movie 1) and coronary cameral fistula from diagonal branch draining into left ventricle. Right coronary artery was normal in origin and super-dominant with severe atherosclerotic narrowing in mid vessel (Figure 2).¹⁾ Aortic root angiogram revealed no coronary artery arising from left sinus of Valsalva (Figure 3). Coronary CT angiography revealed a single, common ostium of the right and left coronary artery arising from the right anterior sinus of Valsalva with anomalous course of the left coronary artery anterior to right ventricle outflow tract which is by definition considered a “single” coronary artery (Figure 3A and 3B) with fistulous communication between one of the distal branch of first diagonal to left ventricle²⁾ Stress MIBI nuclear scan with adenosine was performed to rule out ischemia due to the anomalous vessel and the coronary cameral fistula. There was no stress induced ischemia in left anterior descending territory. Hence percutaneous coronary intervention of right coronary artery lesion was done. At 3 months follow up patient is asymptomatic. In summary this is a case with three in one coronary pathology including atherosclerotic stenosis, single coronary artery and coronary cameral fistula all in one. Multimodality imaging helped us to identify the culprit causing ischemia and to select the optimal treatment strategy.