Bummed and anxious!

[SnakeRiverPirate]

I started OW class through the LDS on Wednesday night, it was great! I had a little problem clearing my ears and they popped for 24 hours after, but all-in-all, I am in love!

I need a note from the doc to get my open water. I have a slight heart defect that has always been called "benign". I was able to serve in the military and this wasn't even found until I was 39.

I saw the Nurse Practitioner at the Heart Institute yesterday. I was due for my annual check up. She said my labs looked great and my BP and weight were good. I asked about a clearance note. She started indicating that I'll need about 3K in tests before they say yes. I am reasonably fit and I swim 1 to 1 and-a-half miles 6 times a week. She finally relented and said that she'd consult with the doc next week and get back with me. The good news there is that the doc is an avid diver.

So I get to sit and worry after having already paid for a class and bought mask, fins and snorkel.

I must admit that I am tempted to go to another doc and bluff him into a note. But I really do want to know if I am at greater risk of a problem. But in reality, I fear they are only going to charge me enough money for a nice vacation so that they can cover their arses.

I'd appreciate feedback on this.

 

[The Chairman]

Is this due to a PFO??? (Patent foramen ovale) Have they given your "defect" a name?

No, I am not a medical doctor: I fix sick networks (or, I used to before SB).

 

[Damselfish]

You'll probably need to be more specific than "slight heart defect" for anyone to have an opinion. I asked a mod to move this to the dive medicine forum.

 

[Indiana Girl]

Why can't you get in to see your doc and get a note from him? Or is it that the heart place has to sign off?

 

[Ann Marie]

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A ScubaBoard Staff Message...

I've moved this thread into Diving Medicine as we've got some great physicians here that can comment.

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You might want to supply your physician/nurse practitioner with the phone number to DAN so that they can confer with another physician if need be.

 

[SnakeRiverPirate]

The condition is called a "muscle bridge". The anterior artery in my heart takes a little dip through the muscle wall instead of running down outside of the wall. I had a little angina when first diagnosed. But I have been able to control my angina by more exercise, dropping a little weight and eating better.

I had to take a stress test (inconclusive), stress thallium (also inconclusive) and finally an angiogram to get diagnosed. I take 25 mg of Coreg 2 times per day. I my heart rate and BP are both great. My bottom line is that I don't want to have to take a 3 thousand dollar test that will come back inconclusive. When first diagnosed with this I had to go through nearly 12K in tests. It was a stupid experience that left me very frustrated. My first doc really wouldn't tell me what was going on. He had me scared to death. After 2 years of that i fired him and got this new doc who indicated that it was nothing to worry about.

Part of the issue is that we had a local Doc (38 years old) stroke out while diving. All his collegues are now heavily in CYA mode.

 

[SnakeRiverPirate]

If we have any physicians here or even folks that spent a night at a Holiday Inn Express, I'd appreciate some feedback. I just am worried about having to dump a ton of money and then get told that I cannot open water dive.

 

[Wozzer]

Howdy,

I'm a senior medical student. So basically it sounds like your left anterior decesending artery (one of the major coronary arteries, supplies most your anterior and inferior left ventricle, which is your major ventricle that pumps blood from your lungs to everything in your body) is somewhat covered by cardiac muscle. I believe the theoretical risk your MD is/was worried about, is that it's possible that muscle could partially occlude the artery when you're exercising, resulting in possible clotting/obstruction of the artery (causing angina, possible MI or "heart attack").

Now did you already get the angiogram? Because that should have a great view of your anatomy and tell you exactly how occluded the artery could be, and if you have any athersclerotic disease (fatty plaques) that would put you at risk of MI.

If you feel comfortable, PM me some information about what medical center you were at. For less common problems, there are certain MD's who are better to see because they more frequently see less common stuff (if that makes sense )

I'm gonna do a bit of research...

 

[fisherdvm]

Didn't read through the rest of the post... Interesting.

 

[Wozzer]

Okay I read a ton of info for ya

What you have is probably best described as "Myocardial bridging of the LAD". Probably somewhere around ~1% of persons have some bridging of at least a little bit of significance, it's not well established how common this really is (it seems a lot of people have tiny insignificant amounts that are probably never ever noticed).

How were you originally diagnosed as having this?

A couple things you should know - beta blockers (like coreg) are fine for you, but make sure no one gives you any nitrates (like nitroglycerin). A lot of people probably carry nitroglycerin and are told to take it for angina/chest pain, but for your condition, they will make things worse so avoid them.

Whether this is going to affect your scuba diving is really based on how bad the vessel is constricted (stenosed). If you've already had an angiogram, then this should tell you. It sounds like you're at a "cardiac center" that is not associated with an academic medical center, those docs are probably not experienced at evaluating this. In that case, it might be possible to take the pictures of your angiogram and have them evaluated by a doctor at a bigger academic center who could give you a better opinion.

If you are exercising hard now, and you can exert yourself as hard as you can underwater without a problem (ie, without angina), I think it's quite unlikely you're going to have a problem.

Do you have any other cardiac risk factors? (diabetes, overweight, high BP, family history)