What is a common non-cardiac cause of chest pain that should be considered on board?

• A. Myocardial infarction.
• B. Pulmonary embolism.
• C. Acid reflux, anxiety, muscular strain.
• D. Aortic dissection.

Answer: (C)

A key idea here is recognizing that chest pain on a flight is often not heart-related. Among non-cardiac causes, acid reflux, anxiety, and muscular strain are particularly common in the cabin.

Acid reflux can flare during travel because cabin pressure changes, meals eaten before or during the flight, and slower gastric emptying can irritate the esophagus behind the sternum. The resulting pain is often a burning sensation, sometimes tied to meals or lying down, and may improve with antacids or sitting upright. Anxiety or panic can produce chest tightness, chest heaviness, rapid breathing, and a sense of impending trouble; this is common in cramped, stressful flight environments and often improves with slow, controlled breathing and reassurance. Muscular strain may come from coughing, tensing muscles due to discomfort or awkward seating, or recent physical activity, and presents as localized chest wall pain that can be reproduced with movement or palpation.

These non-cardiac causes differ from cardiac ones in typical features: non-cardiac pain may be related to meals or posture, might be relieved by rest or antacids, and often lacks the pattern of exertional, radiating pain seen with heart-related events. In contrast, cardiac causes like myocardial infarction, pulmonary embolism, or aortic dissection require urgent assessment due to their life-threatening nature. On board, recognizing that chest pain can be non-cardiac helps guide initial care while you monitor for any red-flag signs that would necessitate escalation.