Cardiac health and paranoia…

[tech_diver]

Ok.. ok… I have lived with the stories of 50-something old dudes like me having sudden and lethal cardiac events. Everyday my inherent hypochondria keeps whispering in my ear as I read about older divers dying during a dive of suspected cardiac conditions. There are all these medical names for the spectrum of cardiac disease but all I hear is nick names like ‘silent killer’ and ‘widowmaker.’

But recently, a celebrity fitness dance instructor went down in the gym with some kind of heart attack, while doing his regular workout and the only reason he survived was that there happen to be doctors working out at the same gym and a hospital was close. So here I am, a balding 53 year old male with knobbly knees committed to a lifestyle of junk food, alcohol and TV viewing watching some fitness guru talk about how he almost died from some type of heart disease.

I recently had a pre-operative physical where they did a heart monitor. The doctor said it looked good but when I asked him what the test looked for, he said it would show damage from previous heart attacks. But really, is that any test that I’m not setting up for the ‘big one?’


For the doctors out there, what types of cardiac tests does a guy need to take to know that he’s not going to drop dead loading tanks?

How expensive and invasive would it be to be confident that a person doesn’t have some widowmaking, silent killer cardiac event around the corner?

Do we even have tests capable of predicting these things?

 

[Wookie]

Newly 54 and 325# here. So, I go to my GP who says "Aside from a BMI of 43, you are fit as a fiddle". Kind of like asking Mrs. Lincoln about the play. So my wife hauls me off to the Cardiologist (who doesn't take my insurance) who does a stress test and a echo-cardiogram. $2k out of pocket. Keeps the wife happy, and the cardiologist says "Your heart looks fine, I don't know why you are short of breath while exercising". Well, Doc, I've never had any wind, that's why I was a sprinter and not a miler. It turns out, if you want to know if you have a widowmaker or blocked coronary arteries, you need to have an angiogram. That's where they inject some dimethyl nastistuff and take an x-ray of your cauliflower shaped growth in the branch leading to your coronary arteries.

But the wife is happy with the stress test and echo-cardiogram, and is off my back about it, and my insurance company renewed my life insurance, and if I die, I won't really know about it. So there is that.

 

[KeithG]

My dive buddy just finished her head to toe medical.

They put her on a treadmill with an ECG thingy to do a cardiac stress test.

Treadmill Stress Testing: Background, Indications and Contraindications, Technical Considerations

 

[Steve_C]

You can do things that lower your odds
You can do things that raise your odds
There is no way you can be 100% positive that you will not drop dead in the next 24 hours.

I will note that it is well known that stress is not a good factor so worrying about it all the time oddly enough is not good.

My dad dropped dead after eating a sandwich at lunch. He would not have passed a dive physical.

So I do the basic tests including treadmill and EKG each year and take my 71 year old body diving. I do avoid strenuous dives and max depth is 100 ft or so but most 90 ft and above.

 

[boulderjohn]

Jim Fixx - Wikipedia

James Fuller "Jim" Fixx (April 23, 1932 – July 20, 1984) was an American who authored the 1977 best-selling book The Complete Book of Running. He is credited with helping start America's fitness revolution, popularizing the sport of running and demonstrating the health benefits of regular jogging. He died of a heart attack while jogging at 52 years of age;
​

If you have a problem like Sudden Cardiac Arrest, it probably won't make a difference whether you are diving or playing golf.

 

[KeithG]

...
My dad dropped dead after eating a sandwich at lunch. He would not have passed a dive physical. ...

Dive physical? Does such a thing exist?

I get a physical every now and then, but my doctor has no idea that I scuba dive. I am not really sure if you get a pass / fail on a physical. So far I am not dead yet.

I checked the standard PADI (RSTC) medical statement thingy and it does not prescribe any tests. It simply hand waves about conditions.

 

[KeithG]

Dive physical? Does such a thing exist?

I get a physical every now and then, but my doctor has no idea that I scuba dive. I am not really sure if you get a pass / fail on a physical. So far I am not dead yet.

I checked the standard PADI (RSTC) medical statement thingy and it does not prescribe any tests. It simply hand waves about conditions.

Oops - I did find a reference to cardio stress testing and 13 METS. But the test is only encouraged if the doctor has some doubts. It is not mandatory.

 

[Steve_C]

When I get my physical I tell the doctor I dive. I ask him if there are any counter indications to any types of activity. Only time he said yes was when I was coming off my one and only bout of pneumonia and I then waited until the lungs were completely clear as verified by xray and examination.

 

[tech_diver]

Awesome answers you guys! I'm sure I could spend hundreds of thousands of dollars searching for various cardiac conditions that I may or my not have. It looks like generally, an echocardiogram and a stress test might be the two tests one would need to really feel ok about one's heart. If it's good enough for Wookie's wife, it's good enough for me.

We'll see if the board medicos have anything else to add. I've avoided looking at my health too deeply because I wanted to avoid being told by a doctor that I have to change my Caligulan lifestyle. But, we get older and times change...

 

[Kevrumbo]

Diving exposes divers' bodies to various stressors that independently affect cardiovascular function. The major stressors are immersion, exposure to cold, increased partial pressure of oxygen and increased work of breathing. The combined effect of these factors is that the volume of blood in the vessels of the chest and heart increases significantly, stretching the walls of heart and large vessels. Pressure in the right atrium and blood pressure slightly increase — -more so in cold water. The heart has to work harder to maintain circulation. These conditions contribute to various arrhythmias, from bradycardia (slow heart rate) caused by cold to tachyarrhythmia (racing heart rate) caused by cardiac and neuroendocrine responses to stress. Older people, especially those with structural cardiovascular changes and weaker function, are at greater risk of adverse reactions to these stresses.

. . ."It is also reasonable to expect diving could provoke an acute arrhythmia, which might result in sudden death. The arrhythmia is a more likely cause of death for older divers. As Carl Edmonds, M.D., describes and DAN® data confirm, "The victim often appeared calm just before his final collapse. Some were unusually tired or resting, having previously exerted themselves, or were being towed at the time — suggesting some degree of exhaustion. Some acted as if they did not feel well before their final collapse. Some complained of difficulty in breathing only a few seconds before the collapse, whereas others underwater signaled that they needed to buddy breathe, but rejected the offered regulator. Explanations for the dyspnea include psychogenic hyperventilation, autonomic-induced ventilatory stimulation and pulmonary edema — the latter being demonstrated at autopsy. In all cases there was an adequate air supply available, suggesting that their dyspnea was not related to equipment problems. Some victims lost consciousness without giving any signal to their buddy, whereas others requested help in a calm manner.". .

Alert Diver | Matters of the Heart