For suspected cardiac chest pain in-flight, what initial medication is commonly recommended if not contraindicated?

• A. Chewable aspirin (162-325 mg)
• B. Nitroglycerin tablet
• C. Epinephrine
• D. Vitamin C

Answer: (A)

Aspirin is the first-line choice here because it directly reduces clot formation in a suspected heart attack. Chewable aspirin at a dose of 162–325 mg acts quickly, since chewing speeds absorption, and it helps limit the progression of a thrombus in the coronary arteries, which can lower mortality if given early and the patient isn’t contraindicated. It’s generally safe for most people, but should be avoided if there’s an allergy to NSAIDs or active GI bleeding or other bleeding risks.

Nitroglycerin can help with chest pain from angina and may be used if there are no contraindications (like hypotension or recent nitrate interactions), but it doesn’t address the underlying clotting that aspirin targets, so it isn’t the universal initial treatment for suspected myocardial infarction. Epinephrine is reserved for allergic reactions, not ACS, and Vitamin C has no role in acute chest pain management.