Isolated dextrocardia in a commercial pilot candidate.

Positional anomalies of the heart are rare and are seldom found during routine physical examinations. We describe the case of a 25-yr-old Swiss airline pilot candidate whose aeromedical examination was normal except that an unusual ECG raised suspicion, leading to a diagnosis of dextrocardia with a normal arrangement of atria and abdominal viscera. This diagnosis in a pilot candidate should raise concern because a high percentage of such individuals have congenital heart defects. Further tests were conducted to rule out associated cardiac malformations, conduction anomalies, or rhythm disturbances. Testing also excluded other associated diseases such as primary ciliary dyskinesia and Kartagener's syndrome. Dextrocardia is not listed as a disqualifying condition in the applicable aeromedical regulations (Joint Aviation Authorities Medical Manual, Joint Aviation Requirements-Flight Crew Licensing guidelines). Therefore, after demonstrating that there were no physical, hemodynamic, or electrophysiological abnormalities, the candidate was allowed to enroll in civilian pilot training without restrictions.