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Coronary slow-flow phenomenon (CSFP) is a frequent angiographic finding with obscure pathophysiology. Although recognized for decades, the incidence of such a clinical entity is rare in aviation environment and poses unique aeromedical challenges in disposition of the aircrew.    Case Details:  A 53-year-old asymptomatic pilot from a helicopter stream was detected to have ECG abnormality during a routine medical examination. His treadmill test was borderline positive for inducible myocardial ischemia, whereas angiography revealed proximal ectasia with a slow flow. He was diagnosed as a case of “Coronary Slow-Flow Phenomenon,” started on antiplatelets and was observed on ground for 36 weeks. A comprehensive cardiological evaluation following that revealed an asymptomatic status, controlled modifiable risk factors and no progression of ECG changes. Echocardiography, 24 h Holter, and stress MPI were essentially normal. Based on an evidence-based approach, the aircrew were reflighted back to flying in a multicrew aircraft.    Discussion:  This case study discusses our approach to aeromedical evaluation and disposition of a helicopter pilot with CSFP, which is unique, yet rarely encountered disability among aircrew.

A rare case of “coronary slow-flow phenomena” in an aviator: An approach to aeromedical disposition – A case report