HISTORY OF FLIGHTOn January 13, 2019, about 1425 central standard time, a Piper PA-28-181 airplane, N75191, was substantially damaged when it impacted terrain about 6 miles south of Salem, South Dakota. The private pilot was fatally injured. The airplane was owned and operated by the pilot as a Title 14 Code of Federal Regulations Part 91 personal flight. Day visual meteorological conditions prevailed in the area and no flight plan was filed for the cross-country flight, which originated from Mitchell Municipal Airport (MHE), Mitchell, South Dakota, and was destined for Mary Skie-Lincoln County Airport (Y14), Tea, South Dakota. About 15 minutes after departing, the pilot contacted Sioux Falls Approach Control and stated that he was having chest pains, was blacking out, and was having difficulty maintaining control of the airplane. About 1411, radar track data indicated the airplane was traveling southeast. The airplane then maneuvered/circled for about 6 minutes, briefly headed northwest briefly and began maneuvering/circling again. The controller continued to communicate with the pilot for about 20 minutes before radio contact was lost about 1425; the track data ended about the same time, about 2 miles southwest of the accident site. The wreckage was subsequently located in a field about 30 nautical miles east-southeast of the departure airport. PERSONNEL INFORMATIONAccording to Federal Aviation Administration (FAA) records, the 69-year-old pilot held a private pilot certificate with airplane single-engine land and instrument ratings. The pilot's most recent third-class FAA medical certificate was issued on October 5, 2016, with a limitation for corrective lenses, and expired on October 31, 2018. On the application for that medical certificate, he reported 2,250 total hours of flight experience, with 50 hours in the previous 6 months. AIRCRAFT INFORMATIONThe four-place, single-engine, low-wing, fixed tricycle landing gear airplane, serial number 28-7690310, was manufactured in 1976. According to maintenance records, the airplane was powered by a 180-horsepower Lycoming O-360 engine, serial number L-1039-36A, which drove a two-blade fixed pitch Sensenich propeller. METEOROLOGICAL INFORMATIONThe 1422 recorded weather at MHE included wind from 200° at 13 knots; 10 statute miles visibility; overcast clouds at 1,500 ft; temperature 1°C; dew point -3°C; altimeter 30.30 inches of mercury. AIRPORT INFORMATIONThe four-place, single-engine, low-wing, fixed tricycle landing gear airplane, serial number 28-7690310, was manufactured in 1976. According to maintenance records, the airplane was powered by a 180-horsepower Lycoming O-360 engine, serial number L-1039-36A, which drove a two-blade fixed pitch Sensenich propeller. WRECKAGE AND IMPACT INFORMATIONThe wreckage was located in a harvested crop field. Review of information and photographs provided by local law enforcement revealed that all major components of the airplane were present at the site. The airplane main wreckage was found resting upright in the field. The cockpit was crushed and the empennage was facing north. A debris field, wheel tracks, and ground scars in the field indicated that the airplane contacted the ground about 600 to 800 ft north of where it came to rest. The wreckage was removed from the scene and was placed in a secure building. The wreckage was subsequently examined by an FAA inspector and airframe manufacturer's representative. The examination revealed no preimpact anomalies that would have precluded normal operation of the airplane. MEDICAL AND PATHOLOGICAL INFORMATIONThe McCook County Coroner coordinated the pilot's autopsy at the Sanford Health Pathology Clinic, Sioux Falls, South Dakota. The autopsy indicated that the pilot's cause of death was multiple blunt force injuries due to an airplane crash due to acute myocardial infarction due to atherosclerotic cardiovascular disease. The autopsy identified coronary artery disease, including 80% stenosis of the left anterior descending coronary artery and 50% stenosis of the right coronary artery. Toxicology testing performed at the FAA Forensic Sciences Laboratory identified valsartan in liver and muscle, ranitidine in muscle, and amlodipine in liver and muscle. Amlodipine is a calcium channel blocker heart medication used in the treatment of hypertension. Ranitidine is used in the treatment of gastric acid secretion. Valsartan is an angiotensin II receptor antagonist indicated for treatment of high blood pressure, of congestive heart failure, and post-myocardial infarction. The pilot's personal medical records indicated that he had well-controlled hypertension and occasional visits for respiratory infections. The pilot requested his primary physician fill out the FAA physician attestation form for BasicMed and the physician did so, attesting to the pilot's ability to safely operate an aircraft. The medical records also included the history form filled out by the pilot during this process; however, the FAA had no record of receiving the pilot's BasicMed documents.