A case of ischemic heart disease (IHD) in a patient with complex dextrocardia is presented. Management of such a patient poses special problem, and a difference in the technique of performing coronary angiography is required. With the right sided aortic arch, Judkins catheters rotated in the direction opposite to normal, result in successful coronary artery engagement. The occurrence of obstructive aortic (atypical coarctation) and large vessel disease was noted in the same patient.