Background <p>We introduce a novel variant of type VI dual left anterior descending artery (LAD), featuring a combination of characteristics observed in the long LAD and a distinct trajectory of the short LAD compared to previously documented cases. Accurate delineation of the dual LAD anatomy holds significant importance for ensuring precise myocardial revascularization planning or making the choice of continue pharmacotherapy alone, thereby it is an essential tool for mitigating the risk of sudden cardiac death.</p> Case presentation <p>This case report highlights the instance of a 42-year-old symptomatic female patient presenting with atypical chest pain, mild repolarization changes on electrocardiogram, but with dual LAD anomaly described at CT coronary angiography. Despite subsequent cardiological reassessment and initiation of beta-blocker therapy, the patient's symptoms persisted without improvement.</p> Conclusions <p>The case presented underlines the critical role of CT coronary angiography in the assessment of patients presenting with chest pain. While we present a benign dual LAD anatomy, the comprehensive assessment of each individual case is crucial for guiding appropriate patient management, particularly concerning revascularization strategies or risk stratification in order to prevent sudden cardiac death.</p>