Spontaneous coronary artery dissection (SCAD) should always be suspected in presence of chest pain during post-partum, since it is one of the possible causes. Strategies for the management of such disease and its complication are not still clearly encoded. A 40-years-old woman was referred with chest pain, started while breastfeeding, associated with an EKG pattern suggesting ischemia. After hospital admission, coronary angiography was performed showing a Type 1 left main coronary dissection. Given persistent symptoms, hemodynamic instability and persistent EKG alterations the patient underwent urgent coronary artery bypass grafting (CABG). Post-surgical period was complicated by severely reduced left ventricular systolic function with secondary pulmonary hypertension, requiring inotropic support and inhaled nitric oxide, respectively. Moreover, apical thrombosis was detected which promoted the adoption of an anticoagulation strategy. Management of lactation was also necessary. Left ventricular dysfunction persisted at discharge and despite prognostic data were in favour of optimal functional recover, the patient was scheduled for a cardiac magnetic resonance for further evaluation and therapeutic assessment.