Visual prodrome and syncope as atypical manifestations of severe triple-vessel coronary artery disease leading to motor vehicle collision: a case report.

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.