Mr. Hung had several underlying conditions, including hypertension, diabetes, dyslipidemia, and sequelae from a previous cerebral infarction, and underwent regular health check-ups. A few days before his trip to Japan, he occasionally experienced chest pain, which subsided with rest, so he did not seek immediate medical attention. After returning home, his pain intensified and radiated to other areas, leading him to visit Tam Anh General Clinic District 7.

Dr. Tran Trung Kien, a specialist in interventional cardiology, stated that cardiac enzyme levels were 416 ng/mL, nearly 30 times higher than normal, indicating acute myocardial damage. Coronary angiography revealed severe narrowing, almost complete blockage, in the right coronary artery and a small branch (OM2) of the circumflex artery, along with diffuse severe narrowing in the left anterior descending artery. The lesions in the right coronary artery and the OM2 branch were the direct cause of localized myocardial ischemia, leading to acute non-ST elevation myocardial infarction. This represents diffuse coronary artery disease; without timely revascularization, the patient faces risks of heart failure, arrhythmias, and sudden death.

The team immediately transferred the patient to Tam Anh General Hospital TP HCM. Dr. Nguyen Minh Chau of the Interventional Cardiology Center placed two appropriately sized stents to expand the vessel lumen and restore blood flow to the heart via the right coronary artery and the circumflex artery. The lesion in the left anterior descending artery did not require immediate treatment; doctors would monitor it and intervene at an appropriate time.

Following the stent placement, Mr. Hung's chest pain resolved. He received intensive medical treatment and was discharged after two days. Doctors advised him to adhere to his medication regimen, attend regular follow-up appointments, and maintain a healthy lifestyle, including at least 30 minutes of daily exercise, limiting salt, sugar, and fatty foods, and increasing his intake of green vegetables and fruits.

Doctors perform an intervention on the patient. *Ngoc Chau*

Non-ST elevation myocardial infarction is a manifestation of acute coronary syndrome. Direct causes can include ruptured or eroded atherosclerotic plaques within the coronary arteries, vasospasm, or blood clots obstructing coronary vessels. Risk factors such as being over 50 years old, smoking, hypertension, diabetes, dyslipidemia, and obesity are also associated with cardiovascular disease.

Doctors diagnose non-ST elevation myocardial infarction based on a combination of patient symptom assessment, necessary tests, particularly cardiac biomarker (troponin) tests, and electrocardiograms. This is crucial because this condition often presents with less specific symptoms or electrocardiogram findings compared to ST elevation myocardial infarction.

Dr. Kien recommends that individuals with multiple underlying conditions traveling internationally or for business trips carry their medications in their hand luggage (not checked baggage), take medications on time according to the local time zone, and store medical records on their phones for easy access. Should they notice any unusual symptoms such as chest pain or pain radiating to adjacent body parts (neck, jaw, back, arms, shoulders, abdomen), shortness of breath, rapid heartbeat, or profuse sweating, patients should immediately call local emergency services to the nearest medical facility.

Ngoc Chau

* Patient's name has been changed