Atrial septal defects represent an abnormal communication between the left and the right atria. Some patients may experience dyspnoea, fatigue, others may suffer directly from complications, like arrhythimias, paradoxal embolisation, resulting in stroke, but some remain asymptomatic until adulthood. When possible, the gold standard treatment is percutaneous closure with nitinol messh occluder. We are presenting the case of a 50-year-old patient with an acute anterior myocardial infarction, whose echocardiography showed akinesia of the left ventricular apex and anterior wall, as well as a surprise element, not connected to the myocardial infarction, a 22 mm atrial defect, with a shunt ratio higher than 1.5. Our first concern was the cardiovascular emergency. The coronarography revealed a critical stenosis of the proximal left anterior descendent and we introduced a stent. In a second phase,we evaluated the atrial septal defect. Since it had indication for percutaneous closure, we decided to use an Amplatzer occluder. The intervention was a success, with no residual shunt. The patient�s follow up was good, with no cardiovascular events. Most of time, cardiovascular diseases are not isolated, but come together, related or not to one another. An adequate management implies treating the cardiovascular emergency first and solving the associated lesions in a second phase.