Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital coronary artery development anomalies disease. We reported a 15-year-old male who presented loss of consciousness and cardiogenic shock after strenuous exercise. After Veno-arterial extracorporeal membrane oxygenation (VA-ECMO), intra-aortic balloon counter-pacing pump (IABP), continuous renal replacement (CRRT) and other comprehensive treatments were given immediately, the patient’s condition gradually improved and was diagnosed as “abnormal coronary origin with acute subendocardial myocardial infarction” by coronary computed tomography angiography (CTA) and cardiac magnetic resonance (CMR). Such diseases progress rapidly and are at high risk of sudden death. Clinicians need to give life supports in time to improve the prognosis of patients.