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A 64-year-old male with a history of thoracic aortic ulcer s/p thoracic endovascular aortic repair presented to the hospital with typical chest pain.His initial physical exam was unremarkable.Cardiac biomarkers were negative on admission and electrolytes were within normal limits.Telemetry revealed a wide complex tachycardia, with 12-lead electrocardiogram confirming ventricular tachycardia.Subsequently, the patient became unstable resulting in direct current cardioversion (DCCV).He subsequently reverted back into ventricular tachycardia requiting additional DCCV, and was then placed on an amiodarone infusion.He underwent emergent left heart catheterization which revealed severe coronary ectasia of the left anterior descending coronary artery and left circumflex coronary artery (Figure 1).Right coronary artery showed severe ectasia with a possible thrombosis distally (Figure 2).Given the patient diffuse and severe disease, percutaneous coronary intervention was not preformed and instead he was evaluated by cardiothroacic surgery.Transthoracic echocardiogram revealed an ejection fraction of 45％ with global hypokinesis.Cardiac magnetic resonance imaging showed scarfing of the basal and mid inferior lateral wall.Rheumatological workup to elucidate any underlying connective tissue disorders was unrevealing.The patient underwent successful five vessel coronary artery bypass grafting and made a full recovery.