Key result
Syncope and visual symptoms present as silent, severe multivessel coronary artery disease requiring urgent CABG.
Why the study?
Non-classical symptoms such as syncope and visual disturbances may delay recognition of severe coronary artery disease in high-risk patients without angina.
Case Report (n=1)
Highlights that severe multivessel coronary artery disease can present atypically with syncope and visual disturbances rather than classic angina, necessitating comprehensive cardiovascular evaluation in high-risk patients.
Answers are grounded in this paper and cite their sources.
May prompt CAD evaluation for atypical syncope or visual symptoms; leaves open the prevalence of such multivessel presentations.
Background: Adverse coronary events usually present with angina, yet non-classical symptoms in the absence of angina may pose as a delay in recognizing severe disease. Case summary: A 65-year-old man presented after a motor vehicle collision preceded by transient illuminated halos in bilateral visual fields. Inpatient evaluation demonstrated anterolateral ST-segment depressions on electrocardiogram, mildly elevated high-sensitivity troponins. Coronary angiography revealed severe triple-vessel coronary artery disease (CAD), prompting a referral to cardiothoracic surgery for quadruple coronary artery bypass grafting. Contributing comorbidities included untreated hypothyroidism, dyslipidemia, prediabetes, obesity, and hypertension. Discussion: This case highlights the importance of recognizing atypical prodromes in patients with silent myocardial ischaemia contributing to CAD, particularly when multiple known cardiovascular risk factors are present. Silent ischaemia may manifest with syncope or visual symptoms. Early recognition, prevention, and treatment of comorbidities through comprehensive cardiovascular risk assessment may help prevent advanced coronary disease and improve outcomes. Even in the absence of chest pain, clinicians should maintain a low threshold for completing cardiovascular risk assessment in high-risk patients presenting with syncope or transient visual symptoms.
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Adnan et al. (2026) conducted a case report in Severe triple-vessel coronary artery disease presenting as silent ischemia (n=1). Atypical manifestation of silent myocardial ischemia was evaluated on Diagnosis of severe multivessel coronary artery disease and subsequent surgical revascularization. A 65-year-old man presenting atypically with syncope and transient visual disturbances without chest pain was found to have severe triple-vessel coronary artery disease requiring urgent quadruple bypass surgery.
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