A 68 year old white male was admitted with syncope to a peripheral hospital. An echocardiogram revealed large pericardial effusion with tamponade. Emergency pericardial window revealed hemorrhagic effusion. A complete work-up revealed a large 6-7 cm aneurysm of the right coronary artery, a 3 cm aneurysm of the left anterior descending, and a 2-3 cm aneurysm of the proximal circumflex with total occlusion distally. The patient had subtotal resection and repair of the right coronary aneurysm, ligation of the LAD distal to the aneurysm, and a triple coronary bypass with successful recovery. It was observed that the right coronary aneurysm had ruptured medially and superiorly.