Another Eagles Nest fatality

[mattia_v]

@mattia_v, how about something like a cardiac CT scan? I had one of these done at my own expense. I wanted to be able to gauge my risk, not only for diving but more generally for putting myself in places in the world that are far from medical care.

Coronary CT (using a modern, low radiation dose per scan CT) has much better sensitivity (so rule out if negative) and decent specificity, particularly if you have a few risk factors based on certain risk score models. There's little strong evidence for screening, however, particularly in the absence of additional risk factors (i.e. diabetes, family history, hypertension, hypercholesterolemia). It's a much better test than a stress test, overall. If you're willing to take the radiation dose (i.e. about 10 14-hour round-trip long-haul flights worth), it can tell you something about your risk of coronary artery disease, but how well that correlates with actual adverse outcomes is still very much in question.

 

[Beau640]

I know mattia_v already knows this but for non medical peeps, pay attention specifically to the statements "There's little strong evidence for screening" and "but how well that correlates with actual adverse outcomes is still very much in question." These tests were not created and are not designed to detect coronary artery disease that is a risk for a diver. Just having coronary artery disease itself does not mean you can not dive or will have a heart attack while diving. Coronary artery disease is what it says it is - disease in the coronary arteries which are the vessels that supply blood to the heart. Now that CT which is finding evidence of calcium deposition (which can be a sign of coronary artery disease) can not tell you necessarily how severe it is or if you should actually be worried about it (for example when you get a cardiac catheterization, you could have anywhere from 1% of a vessel with disease that doesn't really need treatment up to 100%).

For example, if everyone on scubaboard went and got a coronary CT, 30% may have a positive CT for coronary artery disease (just completley made up that number for discussion sake). However, only 5% of that 30% may have an issue with coronary artery disease in their entire life (if the other 25% never got the CT scan they never would have known they had it and it never would have caused an issue in their life span). Of those 5% most would be fine with medication and maybe 1% would need interventions with procedures. Again, all made up numbers but attempting to highlight the "There's little strong evidence for screening" and "but how well that correlates with actual adverse outcomes is still very much in question."

You will get a bunch of incidental findings in people that don't even have symptoms and never would have had an issue with it in the first place. I wouldn't waste your money out of pocket for this (assuming you don't have symptoms) and would not stroll into your docs office demanding a coronary CT. Same reason that routine PFO screening is not recommended - can lead to a bunch of workup/intervention/problems for something that might not ever cause you a problem.