Published: July 31, 2026
A 60-year-old male with no prior cardiovascular diagnoses presented for routine preventive care. The patient was an active runner, including in ultramarathons, with no reported symptoms of coronary artery disease, such as chest pain, shortness of breath, exercise intolerance or fatigue.
His medical history was notable for elevated cholesterol and a significant family history of cardiovascular disease. His mother died of a myocardial infarction at age 59.
During an annual physical examination, elevated cholesterol levels prompted referral for coronary artery calcium scoring.
The patient’s calcium score was 975, indicating extensive coronary artery calcification and a high risk for significant coronary artery disease. Additional diagnostic imaging and physical assessment identified severe multivessel coronary artery disease involving the left anterior descending, left circumflex and right coronary arteries.
A CT angiogram with fractional flow reserve demonstrated hemodynamically significant reductions in blood flow across all three major coronary arteries.
Despite the absence of symptoms and a high level of physical fitness, the patient was found to have advanced coronary artery disease that placed him at substantial risk for myocardial infarction and other adverse cardiac events.
Further evaluation showed no evidence of irreversible myocardial damage, creating an opportunity for intervention before a cardiac event occurred.
Given the extent and severity of the patient’s coronary artery disease, Norton Heart & Vascular Institute’s multidisciplinary team recommended surgical revascularization through a coronary artery bypass grafting (CABG) procedure.
The patient underwent successful five-vessel coronary artery bypass surgery at Norton Audubon Hospital, performed by Steven W. Etoch, M.D., cardiothoracic surgeon with Norton Heart & Vascular Institute, and other members of the institute’s cardiovascular team.
The CABG procedure restored blood flow to areas of the heart affected by severe arterial blockages and reduced the patient’s risk of future cardiac events.
Postoperatively, the patient progressed as expected. Within days, he was walking independently through the hospital. He was discharged home later that week to continue recovery.
The patient experienced an uncomplicated recovery following the CABG procedure.
Postoperative echocardiography showed preserved cardiac function with no evidence of significant myocardial impairment.
The patient returned to physical activity in a gradual, supervised manner. Two months after surgery, he completed a 5K event. Four months later, he completed a half-marathon, demonstrating a successful return to endurance exercise.
He continues routine cardiovascular follow-up and remains active with no significant limitations.
Coronary artery disease may progress silently, even in individuals who are highly active and otherwise appear healthy.
This case highlights the value of preventive cardiovascular screening, particularly for patients with elevated cholesterol, significant family history or other risk factors for heart disease. Early identification of severe coronary artery disease allowed treatment before the onset of symptoms, myocardial infarction or permanent heart damage.
“People assume that if they’re active and feel fine, they’re safe,” Dr. Etoch said. “This patient demonstrates that significant coronary artery disease can exist without symptoms. Early detection provided an opportunity to intervene before a life-threatening cardiac event occurred.”