A 28-year-old woman presented with atypical chest pain and long-standing upper limb claudication. She had no cardiovascular risk factors. Radial and brachial pulses were absent and blood pressure un-recordable. Investigation revealed bilateral calcified coronary aneurysms (Figure 1), with significant proximal left anterior descending and right coronary artery stenoses immediately distal to the aneurysms. Magnetic resonance imaging confirmed the underlying diagnosis of Takayasu arteritis, with multiple artery occlusions, well-developed collaterals and no evidence of active vasculitis. Stress echocardiography excluded inducible myocardial ischemia. Known as “pulse-less” disease, Takayasu arteritis typically affects young females, resulting in granulomatous large-vessel vasculitis with arterial stenoses, occlusions and aneurysms.1 Although the pattern of coronary disease in this case is highly unique, coronary involvement is not infrequent and is often overlooked.2 As there was no evidence for active vasculitis or myocardial ischemia identified, management was conservative.