An Incidental Diagnosis of Silent Myocardial Ischaemia: A Case Report

Background: Silent myocardial ischaemia (SMI) is a recognised but often underdiagnosed manifestation of coronary artery disease, especially in patients with diabetes mellitus. Autonomic neuropathy can blunt classical anginal symptoms, leading to delayed diagnosis and subsequent poorer outcomes. Case Presentation: We present the case of a 66-year-old man with type 2 diabetes mellitus who attended a routine primary care review complaining only of fatigue. He denied chest pain or typical anginal symptoms. Initial investigations revealed electrocardiographic changes consistent with a previous inferior myocardial infarction. Subsequent cardiology assessment confirmed a diagnosis of silent myocardial infarction secondary to underlying coronary artery disease. Conclusion: This case highlights the importance of clinical vigilance for atypical presentations of myocardial ischaemia in patients with diabetes. Early recognition through routine assessment and appropriate investigation is essential to reduce cardiovascular morbidity and mortality in this high-risk population.