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Background: Acute coronary syndrome is predominantly attributed to atherosclerotic coronary artery disease. However, structural diseases leading to compromised coronary flow can also lead to similar manifestations. Case presentation: A 35-year-old male had presented with acute coronary syndrome (ACS) NSTEMI and was found to have a cyst on echocardiogram, which was compressing on the left circumflex coronary artery. Conclusion: Structural diseases including both developmental and anatomical lesions should be considered as a differential in the etiology of acute coronary syndrome in a young individual without any pre-existing co-morbidities.