Background: the average amount physical activity of women in Saudi Arabia predisposes them to ischemic heart disease, in an otherwise completely healthy individual. Aim: To emphasize the significance of lack of physical activity alone on cardiovascular health. Case report: this case report describes an acute onset of severe coronary syndrome of a middle aged Saudi woman with no other cardiac risk factors. Treadmill test was positive for inferolateral ischemia. CT angiography revealed occluded arteries in five different locations. A PCI was performed after three months to achieve complete vascularization. Conclusion: normal lifestyle of women in Saudi Arabia should be considered very sedentary and a major risk factor of ischemic heart diseases.