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Bratface:
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Angina - How does it effect diving ?
- Thread starter Laura0314
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This thread has been edited to remove personal attacks, sarcasm, and rudeness. Please keep it polite and on topic.
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This thread has been edited to remove personal attacks, sarcasm, and rudeness. Please keep it polite and on topic.
Thanks!
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Edited to remove phallic reference.
Sorry to arrive late to the bashing session. As mentioned above, there is no privacy issue here as no identifiable information has been given.
As TSandM mentioned a couple of pages ago, I am a cardiologist who also has an interest in (and lectures on) diving medicine. Back to the original topic ---
The first issue is "angina" -- that is a symptom and doesn't automatically mean your firend has any problems whatsoever. Lots of things can cause chest pain -- one of which is coronary artery disease. Classically "Angina" is substernal chest discomfort (you'll notice I didn't use the work PAIN) which is predictably brought on by exertion or strong emotion and is predictably relieved by rest or nitroglycerin. "Atypical angina" has two of these features but not the other while "Atypical chest pain" has only one of the three components. The predictive nature for coronary artery disease depends on the nature of the symptoms and the gender of the patient. A 50 year old male with classic angina has a 90% chance of having coronary artery disease while atypical angina has only a 50% predictive accuracy and atypical chest pain only 15%. Note this is for a 50 year old man. A 50 year old woman has only a 50% chance of coronary artery disease despite "classic angina". Don't get lost in the numbers -- just realize that chest pain which someone may call "angina" can be from lots of things.
Now, on to your friend. CT angiography (CTA) is an exciting new tool but is not a "gold standard" by any means. Currently, the technology can detect coronary artery disease but its ability to accurately determine the degree of narrowing in a coronary artery is somewhat limited. It is felt that the values are probably +/- 30%. That means that a "50%" narrowing by CTA is somewhere between a 20% and 80% narrowing -- not really helpful to me as a cardiologist. Putting all of the data you present it looks like your friend has some amount of narrowing in his proximal LAD but probably not critical, no significant disease in the circumflex or RCA, and has normal heart muscle function. What he needs is aggressive risk factor modification (blood pressure control, smoking cessation, diabetes control, cholesterol lowering, etc) as appropriate. Additionally, it would be reasonable to proceed with stress testing (probably with some form of nuclear or echo imaging) to determine how "physiologically" important this narrowing on CTA is. If he has a normal stress test then he should have no limitations on his activities (diving or otherwise) and just needs the risk factor modification mentioned above. However, should he have an abnormal stress test he should undergo a heart catheterization for possible intervention with stenting. It would be unlikely in this day and age to require bypass surgery for a single vessel blockage of the proximal LAD.
To take the discussion one step farther, let's say he does have an abnormal stress test that results in a cath and a stent. The recommendation for returning to diving would be to wait six months to make sure there was no renarrowing of the stent. At that time if a follow-up treadmill showed no evidence of significant renarrowing of the stent, he had good exercise tolerance (13 mets on a treadmill), and normal heart muscle function he could return to diving (recreationally or as an instructor for that matter) without restrictions. One exception is commercial diving which is another ballgame.
Anyway, sorry for the longwinded comments but I hope this helps. If you have any other questions please feel free to PM me. just my 2 cents. And, as always, the best advice is to discuss these issues with the patient's primary physician or cardiologist. If they do not feel qualified to discuss diving questions, contact DAN to be referred to a qualified diving physician in your area.
Doug
As TSandM mentioned a couple of pages ago, I am a cardiologist who also has an interest in (and lectures on) diving medicine. Back to the original topic ---
The first issue is "angina" -- that is a symptom and doesn't automatically mean your firend has any problems whatsoever. Lots of things can cause chest pain -- one of which is coronary artery disease. Classically "Angina" is substernal chest discomfort (you'll notice I didn't use the work PAIN) which is predictably brought on by exertion or strong emotion and is predictably relieved by rest or nitroglycerin. "Atypical angina" has two of these features but not the other while "Atypical chest pain" has only one of the three components. The predictive nature for coronary artery disease depends on the nature of the symptoms and the gender of the patient. A 50 year old male with classic angina has a 90% chance of having coronary artery disease while atypical angina has only a 50% predictive accuracy and atypical chest pain only 15%. Note this is for a 50 year old man. A 50 year old woman has only a 50% chance of coronary artery disease despite "classic angina". Don't get lost in the numbers -- just realize that chest pain which someone may call "angina" can be from lots of things.
Now, on to your friend. CT angiography (CTA) is an exciting new tool but is not a "gold standard" by any means. Currently, the technology can detect coronary artery disease but its ability to accurately determine the degree of narrowing in a coronary artery is somewhat limited. It is felt that the values are probably +/- 30%. That means that a "50%" narrowing by CTA is somewhere between a 20% and 80% narrowing -- not really helpful to me as a cardiologist. Putting all of the data you present it looks like your friend has some amount of narrowing in his proximal LAD but probably not critical, no significant disease in the circumflex or RCA, and has normal heart muscle function. What he needs is aggressive risk factor modification (blood pressure control, smoking cessation, diabetes control, cholesterol lowering, etc) as appropriate. Additionally, it would be reasonable to proceed with stress testing (probably with some form of nuclear or echo imaging) to determine how "physiologically" important this narrowing on CTA is. If he has a normal stress test then he should have no limitations on his activities (diving or otherwise) and just needs the risk factor modification mentioned above. However, should he have an abnormal stress test he should undergo a heart catheterization for possible intervention with stenting. It would be unlikely in this day and age to require bypass surgery for a single vessel blockage of the proximal LAD.
To take the discussion one step farther, let's say he does have an abnormal stress test that results in a cath and a stent. The recommendation for returning to diving would be to wait six months to make sure there was no renarrowing of the stent. At that time if a follow-up treadmill showed no evidence of significant renarrowing of the stent, he had good exercise tolerance (13 mets on a treadmill), and normal heart muscle function he could return to diving (recreationally or as an instructor for that matter) without restrictions. One exception is commercial diving which is another ballgame.
Anyway, sorry for the longwinded comments but I hope this helps. If you have any other questions please feel free to PM me. just my 2 cents. And, as always, the best advice is to discuss these issues with the patient's primary physician or cardiologist. If they do not feel qualified to discuss diving questions, contact DAN to be referred to a qualified diving physician in your area.
Doug
