Coronary dystrophy is characterized by the presence of successively stenotic and ectatic or even aneurysmal zones in the coronary network. The authors report a new case of coronary ectatic dystrophy presenting in with myocardial infarction. They review the literature and suggest the various aetiologies, the main one being atherosclerosis. The management of this particular form of atherosclerosis is dominated by the thromboembolic risk related to these aneurysmal zones responsible for myocardial infarction, justifying long-term anticoagulant therapy.