Acute coronary syndrome (ACS) commonly result from atherosclerotic occlusion of coronary arteries but rarely coronary spasm, substance abuse, systemic vasculitis and coronary embolism can cause the ACS with normal coronary arteries. Acute myeloid leukemia (AML) has been reported as a rare cause of ACS, here we report a 50 year old male, severely anemic, non–diabetic, non–hypertensive, alcoholic and smoker who presented with severe retrosternal chest pain.  Search for secondary cause of ACS in view of severe anemia revealed him to be suffering from AML. He was treated for ACS and chemotherapy was planned for AML.