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In-flight angina pectoris; an unusual presentation
Firas Al-Janabi1,2, Regina Mammen3, Grigoris Karamasis4,5
1Essex Cardiothoracic Centre, Basildon Hospital, Nethermayne, Basildon, Essex, SS16 5NL, UK. firas.aljanabi@btuh.nhs.uk.
BMC Cardiovascular Disorders
|April 28, 2018
Summary
A man experienced angina (chest pain) for the first time during a long flight due to physiological stress like hypoxia. This highlights how altitude can trigger underlying coronary artery disease, even without prior symptoms.
Area of Science:
- Cardiology
- Aerospace Medicine
Background:
- Coronary artery disease (CAD) can manifest atypically under physiological stress.
- Long-haul flights induce physiological changes including hypoxia and increased cardiac output.
Observation:
- A 68-year-old man with no prior cardiac history presented with new-onset angina during a long-haul flight.
- Symptoms resolved upon landing and recurred on subsequent flights, indicating a link to flight-induced stress.
- Coronary angiography revealed significant stenosis in the left anterior descending and right coronary arteries.
Findings:
- The patient's angina was triggered by the physiological demands of high altitude, including hypoxia and increased cardiac workload.
- Invasive measurements confirmed the physiological significance of the coronary artery lesions.
- Successful treatment with drug-eluting stents eliminated flight-related angina symptoms.
Implications:
- Clinicians should consider altitude and physiological stress as potential triggers for myocardial ischemia, even in patients without exertional angina.
- Underlying coronary artery disease may remain undiagnosed until exposed to significant physiological stressors.
- This case underscores the importance of evaluating cardiovascular health in individuals undertaking air travel, especially those with risk factors.
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