Close Call; Glad I could write this incident report.

[Barracuda2]

I asked my Dr. about beta blockers for a medical condition I had a few years ago (that's the reason I knew something about them ) and while she isn't a dive-medical expert she said to me, and I quote, "I would find scuba diving on beta blockers inadvisable". Upon asking follow up questions her opinion was based on beta blockers effectively lowering (damn, I can't think of the English word right now..) "inspanningstolerantie"... I guess literally translated it means "tolerance to endure exercise". It had to do with the limiting effect on how high the heart-rate can get. She described exactly what the OP said, which is that high levels of exercise, like jogging, can cause you to feel exhausted. Her opinion (and again, she doesn't have a dive-medical specialty) was that feeling exhausted on scuba probably wasn't a good idea.

I was using Atenolol, a beta-blocker, at the time of the incident. I have since switched to a calcium blocker. I need to find out how this may effect the situation. I agree that the Atenolol contributed to my IPE hit. I have had A-fib 3 times in 7 years and the last time I had to be converted by shock. That's the only reason I was put on that med. I'm doing more research to see if I can drop all meds for this condition since it does not happen very often.

 

[InTheDrink]

I should have mentioned that in my incident I had taken a beta blocker. Needless to say I haven't taken one since.

 

[DandyDon]

I should have mentioned that in my incident I had taken a beta blocker. Needless to say I haven't taken one since.

Uh, do we need to campaign for warnings...?!

 

[InTheDrink]

Yes probably. The counsel I have received has been that by themselves they are unlikely to actually cause IPE however throw in a few additional factors and the beta blockers may be part of the 'perfect storm'.

My ultimate recommendation however is to try to not work hard underwater but this is purely from a novice without any medical knowledge. Irrespective of IPE I think it's still got advice.

John

---------- Post added March 1st, 2013 at 06:46 PM ----------

Got = good. Damn you iPhone autocorrect.

---------- Post added March 1st, 2013 at 06:49 PM ----------

Sorry Don, to be more explicit yes I think that until we can prove otherwise diving with propranolol (beta blocker) is probably unwise. I certainly wasn't aware prior to my incident. I also lied on my med form about taking any medication as I thought beta blockers weren't relevant. My very very bad.

 

[DandyDon]

I posted the question on Dive Medicine: http://www.scubaboard.com/forums/di...e-need-warn-against-diving-beta-blockers.html

 

[John C. Ratliff]

Baracuda2,

My wife is a hospital pharmacist, and from discussions about a completely different situation I found that people with atrial fibrillation sometimes are placed on blood thinning agents. This is because that condition can lead to blood clots forming in the atrium, and then having them circulate to the brain--which is a stroke. The person had an operation for hiatal hernia and was taken off the blood thinning agents. Apparently, after this operation he was not put back on the blood-thinning agent, and had a subsequent stroke. Hopefully, your condition is not one which requires this, but I thought it was worth the mention.

SeaRat

 

[Barracuda2]

Baracuda2,

My wife is a hospital pharmacist, and from discussions about a completely different situation I found that people with atrial fibrillation sometimes are placed on blood thinning agents. This is because that condition can lead to blood clots forming in the atrium, and then having them circulate to the brain--which is a stroke. The person had an operation for hiatal hernia and was taken off the blood thinning agents. Apparently, after this operation he was not put back on the blood-thinning agent, and had a subsequent stroke. Hopefully, your condition is not one which requires this, but I thought it was worth the mention.

SeaRat

I have never been put on a blood thinning agent. If someone in the know can answer this: Is 3 episodes of A-fib over a 7 yrs. span considered frequent, or non-consequential? No docs can find any physical reason for these episodes, so they tend to connect it with stress or anxiety. With me, I agree on the stress and anxiety trigger. Maybe John C. Ratliff's wife can answer this.

 

[raftingtigger]

Couple of comments on beta blockers and on blood thinners.

Beta blockers work by 2 routes. #1 they reduce the ability of the heart to beat faster - decreasing the workload and oxygen demand of the heart (negative chronotrope). #2 they reduce the ability of the heart to beat forcefully - again decreasing the workload and oxygen demand of the heart and the blood pressure in the system (negative inotrope). They are effective medicines, but do prevent increasing oxygen delivery under higher physical workloads. In plain English, they significantly decrease exercise tolerance.

Blood thinners for atrial fibrillation: The heart is 2 separate pumps side by side; one pumps blood to the body (left side) and the other pumps blood to the lungs (right side). Each pump has 2 chambers; the atria - helps fill the ventricles; and the ventricles - pumps the blood into the respective circulations. Fibrillation is a ineffective quivering of the chamber and pumps no blood. If the ventricle fibrillates, then the person dies without immediate treatment. This is the most common cause of cardiac arrest. If the atria fibrillates, not much happens unless the whole heart beats too fast. People live normal lives with the atria in constant fibrillation (atrial fibrillation or a.fib for short). A.fib has 2 dangers. First is the entire heart beating too fast. This is where the beta blockers come in. They are used for heart rate control. The second danger is having a blood clot or clots form in the poorly emptying atria. Since the blood in the atria isn't emptying well, it stagnates. Stagnant blood tends to clot. Clots in the heart are then sent out to either the lungs or the body (including the brain). A clot in the lung can cause death with a pulmonary embolus (prevents oxygenation of the blood) or a clot to the brain causes a stroke. How much damage depends on the size of the clot and where it lodges. Blood thinners (coumadin, warfarin) are used to reduce the risk of a blood clot. They have their own dangers - but not really and issue here.

As for Barracuda2's question: 3 episodes in 7 years, I can see his doctor advising either way. But blood thinners by themselves shouldn't change his exercise tolerance. Beta blockers certainly can.

 

[Barracuda2]

As for Barracuda2's question: 3 episodes in 7 years, I can see his doctor advising either way. But blood thinners by themselves shouldn't change his exercise tolerance. Beta blockers certainly can.

And they surly did affect my exercise tolerance. Sometimes I could barely get into an exercise routine and my heart would start skipping. It makes sense to me that I could conclude easily that my IEP hit can be connected to the Beta Blocker I was on at the time; at the least, a contributing factor. My heart was not working efficiently for the activity I was doing; thus, a chain reaction starts in my body that ends up with me sucking air like a fish out of his element. I have stopped the Atenolol and have recently taken myself off the Flecanine Acetate. I can already notice the difference in the way my chest feels, my heart feels (no more random erratic heart beats); and my overall general physical being. Maybe the dive docs need to take a closer look at this; it could save a life.

 

[InTheDrink]

I don't think many ppl properly appreciate the impact meds can have when diving unless something happens and then they appreciate it in a fairly large way.

I can't iterate enough that of you're on any meds get them cleared by a dive physician. And your GP is not a dive physician.