We present a case of a 17-year-old White male high school American football player who was diagnosed with an anomalous left coronary artery arising from the right coronary sinus after experiencing dizziness, near-syncope, and altered mental status during a football practice. The symptoms were recognized by an on-site certified athletic trainer who activated emergency medical response. After unremarkable initial emergency evaluation, referral to a sports cardiologist unveiled an anomalous left coronary artery arising from the right coronary sinus on echocardiogram. After surgical correction and rehabilitation, the patient was able to return to exercise activity. Anomalous coronary arteries are the second most common cause of autopsy-positive episodes of sudden cardiac death among athletes and are rarely recognized with abnormal electrocardiogram (EKG) findings prior to events. This case highlights the importance of prompt recognition, evaluation, and treatment of athletes with cardiac symptoms, and contributes to an ongoing discussion on whether echocardiograms should be considered in preparticipation evaluations.