Cardiac ultrasound for everyone considering diving?

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manchester ct
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I went to my doctor to get my release form signed for the open water dives to complete my PADI open water certification and my doctor tells me that he advises all his patients who want to dive to get a cardiac ultrasound even if, like me, they have no medical problems. He says he is concerned that some patients may have a condition called atrial septal defect (ASD) that could put them at higher risk for dive injuries. ASD is a hole between the upper chambers of the heart through which blood or nitrogen bubbles can pass. I researched ASD and found that about 25% of the population has it. Normally I would just go and get the test but I have a high deductible health plan. So the $600 is out of my pocket. Here is a link with some more information on ASD and other heart problems that can interfere with diving: www.cachnet.org/learning_scuba.html
 
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Sounds like CYA medical advice. If it were a real problem for diving a significant amount of the time, and 25%of people have it, then 25% of people would get sick when diving, right? It seems that respiratory function tests would be more useful, and cardiac stress tests, and requiring a BMI below x% and......how many tests would it take for the doctor to feel s/he has covered all the bases if it were to go to litigation?
 
Sounds like you need to find a new doctor.
 
Here's DAN's take on atrial septal defect: DAN Divers Alert Network

I have never heard of screening for it as part of a routine examination to clear a patient for diving. It doesn't sound like the worst idea in the world, but it does seem outside the norm. Search the Dive Medicine Forum (or re-post the question there) for the posts of DocVikingo, TSandM, Duke Dive Medicine, and especially debersole, who is a cardiologist, for more informed answers.
 
It's not like ultrasound is ionizing radiation (like x-ray or CT), so go for it.

Don't expect insurance to pay, however, because there's no corresponding ICD code for a diagnosis of "scuba diving". ;)
 
So in people with unexplained DCS hits, ASDs/PFOs are seen in greater frequency than in those without. But lots of people with ASDs/PFOs don't have DCS hits. So therefore, no one recommends routine screening for ASD.

There you have it. Unless you have history to support this screening, Next doc.
 
It's not like ultrasound is ionizing radiation (like x-ray or CT), so go for it.

Don't expect insurance to pay, however, because there's no corresponding ICD code for a diagnosis of "scuba diving". ;)

Cost of a test isn't the only or even the main issue. If the test shows a defect, what do you do? If the test is inconclusive, what do you do? Is an increased probability of DCS, itself a very low probability, worth not diving? What is the risk of surgery or follow-up tests compared to the risk of diving with the condition, or with a higher likelihood you have the condition (if the test isn't conclusive)?
 
Why do you need the release form? Do you have one of the reportable medical conditions that would require a sign off from a doctor or is this a CYA requirement of the dive shop

If the first, I would get a recommendation for a doctor from DAN , see him and follow his advise. For the second, get a new dive shop.
 
Cost of a test isn't the only or even the main issue. If the test shows a defect, what do you do? If the test is inconclusive, what do you do? Is an increased probability of DCS, itself a very low probability, worth not diving? What is the risk of surgery or follow-up tests compared to the risk of diving with the condition, or with a higher likelihood you have the condition (if the test isn't conclusive)?
@jaytee0471: If you are an otherwise healthy person, your physician is making a non-standard recommendation.

walrus2 is asking all of the right questions. I'd pose those same questions to your physician. I doubt he'll be able to justify his recommendation using studies in the scientific literature.

FYI, you have every right to politely decline the suggestion for PFO testing.

Enjoy your scuba class.
 

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