The study reports the case of a patient with multiple aneurysms and ectasias of the coronary arteries whose first manifestation was acute coronary syndrome. This is a 42-year-old male patient who was diagnosed with acute myocardial infarction without ST segment elevation. Cineangiocoronariography showed a three-vessel lesion with aneurysmatic and ectatic coronary dilations. Myocardial revascularization surgery was chosen, but he refused to undergo surgical treatment. He was discharged with optimized clinical treatment with outpatient follow-up. Months after diagnosis, the patient died and was being followed up in another service. Coronary artery aneurysm is a rare entity. The ideal management is still not well established, with doubts and disagreements about surgical and interventional treatment and when to indicate them.