Introduction: The cardiovascular involvement is one of the most severe manifestations of the autoimmune diseases, having a very complex ethiopathogenesis. Case presentation: A 73 year old woman, with a known immune pathology (Lupus erythemathosus – Scleroderma overlap syndrome, Raynaud syndrome, antiphospholipid antibody syndrome) and an important cardiac pathology (2 myocardial infarctions, PTCA of the circumflex coronary artery, mitral regurgitation and aortic disease) presented with dyspnea, orthopnea, and permanent fatigue, symptoms that have been worsening during the last three months, with exacerbations. Methods: Clinical exam: facial skin tightening, sclerodactyly, BP 100/50 mm Hg, HR 92 bpm; mitral systolic murmur, aortic systolic murmur, aortic diastolic murmur. Laboratory tests: normochromic anemia, high level serum creatinine. ECG: old myocardial infarction. Chest X-ray: enlarged heart with aortic calcifications. Echocardiography: lateral and anterior wall hypokinesis, decreased LV systolic function, severe mitral regurgitation, moderate aortic regurgitation, large aortic stenosis, minimal pericardial effusion. Abdominal ultrasonography: dilated inferior vena cava and suprahepatic veins. Results: With the surgical risk being deemed superior to the estimated benefit, we decided for a conservative treatment. The patient had a favorable outcome with therapy (including a loop diuretic, beta-blocker, antiplatelet, statin and the treatment for the overlap syndrome). The particularity of this case is the conservative management of the cardiovascular disease in a patient with a severe valve disorder and overlap syndrome with clinical improvement. Conclusions: The diagnosis and the treatment of the cardiac disease have a great importance on the evolution and prognosis of the autoimmune disorder. The complex ethiopathogenetic, clinical and therapeutic aspects of the cardiovascular involvement in the overlap syndromes require a complex, multidisciplinary approach.