Angina and fitness to dive question

[Ber Rabbit]

I'm not having much luck finding information about angina.

Lets say a 20 something diver marks angina on the medical release but they have had an echocardiogram and stress tests that came up negative and nothing abnormal was found. Is that an absolute contraindication?
Ber

 

[Cacia]

If the stress test was negative, I think not.
That's the problem with those PADI forms.
I mean, it sounds like he has been worked up and ruled out.
If he has, his cardiologist would probably be willing to write a letter, clearing him to dive. From what I know....

 

[TSandM]

Angina pectoris is chest pain caused by insufficient blood supply to cardiac muscle. More or less by definition, a patient with angina pectoris should, in my opinion, not be underwater.

A patient in his 20s, even in today's obese world, is at low risk for coronary artery disease absent certain familial problems. If he's been evaluated by a cardiologist and not felt to have coronary artery-related chest pain, he's likely okay (although a stress test is not the gold standard for evaluation of coronary artery anatomy). But from a legal standpoint, somebody who says they have "angina" is telling you they have cardiac ischemia, and I wouldn't assume responsibility for this person underwater without a letter from a cardiologist clearing him.

Most likely the patient doesn't understand what angina is.

 

[Cacia]

Most likely the patient doesn't understand what angina is.

Patients use that word wrong all the time, don't they?

Question: Does the stress test ever turn up negative, the ECG negative, and the cardiologists still feel it is cardiac ischemia? If so, how often?

Would they cath that guy? In other words, what is usually the "definitive" rule out test?

Since the stress test is done under physical exertion, wouldn't it in some ways offer information that even the visualization of the fluroscopy couldn't?

 

[DocVikingo]

Hi catherine96821.

1. (Q) "Patients use that word (angina) wrong all the time, don't they?"

(A) On occasion patient's use of that word can be confusing to both cardiologists and gynecologists.

2. (Q) "Does the stress test ever turn up negative, the ECG negative, and the cardiologists still feel it is cardiac ischemia? If so, how often?"

(A) Exercise stress testing essentially is an ECG, so it's important to keep ECGs straight here. It is not uncommon for a resting ECG to be normal in the face of ischemia sufficient to cause complaints of chest pain. It is more unusual for an exercise tolerance ECG to be WNL given ischemia severe enough to cause pain, but negative results do occur.

3. (Q) "Would they cath that guy? In other words, what is usually the "definitive" rule out test?"

(A) The definitive rule out test is selective coronary angiography. However, the definitive rule out work up would also include exercise EKG, radioisotope scanning (especially in women), physical examination and a variety of blood tests.

4. (Q) "Since the stress test is done under physical exertion, wouldn't it in some ways offer information that even the visualization of the fluroscopy (sic) couldn't?"

(A) Yes, tests which image/observe anatomical structures v those that measure physiology/function typically yield different information.

Regards,

DocVikingo

 

[Dr. Doug Ebersole]

I'm late to the party again, but I agree with everything above. As a cardiologist, I see people with "angina" all the time. A large proportion of those, especially young people, do not have underlying coronary artery disease. There is simply another cause of the chest pain that they are calling "angina" that is masquerading as heart pain. In a 20-something year old with a normal stress test it would be EXTREMELY unlikely that they have underlying coronary artery disease despite their risk profile. However, if they answer "yes" to angina on the form you need a clearance from a physician before letting that person dive. To put a number on catherine96821's question, likelihood of a normal stress test in the setting of significant coronary artery disease is around 10-15%, depending on the population of patients studied. Nuclear perfusion imaging improves this number. Women, by the way, are more likely to have falsely abnormal stress tests but not falsely normal results. Because of this high "false-positive" rate, a lot of cardiologists go straight to nuclear imaging in women (controversial).