Syncope as the Sole Presentation of Multi-Vessel Coronary Artery Disease.

Defining the etiology of syncope can be occasionally challenging. We present a case with no history of coronary artery disease (CAD) who presented exclusively with exertional syncope, and was found to have mildly reduced left ventricular systolic dysfunction on echocardiogram and severe multi-vessel CAD with chronic total occlusion (CTO) of the right coronary artery (RCA). Syncope as the initial presentation of advanced CAD in the absence of classic ischemic symptoms is rather an uncommon presentation in clinical practice.