Coronary artery disease and diving

[Jersey]

NOT medical advice, just my experience. My 63 yr old buddy/partner told me at dinner in April 2024 he had bilateral jaw pain on exertion for about 10 minutes - like a brisk walk from his office to the plant .5 mile away - then it stopped. I told him classic heart blockage issue (and he replied 'you're not a Doctor').

June found blocked coronary arteries - like 89-99%. Angiplasty in Sept opened 1 w a stent, but failed for 2 and LAD was blocked so CABG was indicated. Mid - November he had double bypass, spent 3 days in hospital, came home walking up to a mile once or twice a day (slowly). He was tired and lost weight, but recovery was a linear progression.

January 2 he was back at work. Mid - February he ran 12.8 METS on the treadmill with no issues. (DAN recommends 13 for diving.) No anomalies on EKG, no jaw pain. He was granted medical clearance from diving docs to resume. We spent the latter part of March and early April diving Bonaire.

My thinking is he was in really good condition prior to discovering the blockages, which it sounds like you are as well, active, exercising, no weight issues. There was no damage to heart. He literally walked into the surgery as opposed to be wheeled in with techs pound his failing heart.

Yes, diving is possible for some at least, maybe not all. Only you and your doctor can determine a treatment plan and next steps. But - like my partner, you found your issue before any significant events or damage occurred. How many are walking around with no idea?

Good luck!

 

[Barryattle]

The short answer is it depends.

The longer answer is… it depends.

The following is for educational purposes only. It is not meant to diagnose or treat any of your conditions. Please seek the advice of your own clinician.

For a great period of time simple plumbing mindset was applied to coronary circulation. It was felt that clearing the blockages would always result in better health for the patient.

Several years ago, a sham controlled randomized trial proved that stable coronary artery disease showed no improvement via stenting versus medical treatment.

Additionally, there’s been research that is shown that clearing a coronary artery obstruction when the body has already established collateral circulation also did not offer any significant improvement in outcomes.

Due to the CAD a patient will always be at some degree of risk. However, CAD is a fairly common diagnosis that I have no doubt hundreds, if not thousands, of people dive with daily. Some have already survived their first heart attack.

The existence of CAD does place a patient at higher risk than someone without, but that risk is all relative.

“After adjustment, 1-year MI rates increased with increasing CAD extent. Relative to patients with no apparent CAD, patients with 1-vessel nonobstructive CAD had a hazard ratio (HR) for 1-year MI of 2.0 (95% CI, 0.8–5.1); 2-vessel nonobstructive HR, 4.6 (95% CI, 2.0–10.5); 3-vessel nonobstructive HR, 4.5 (95% CI, 1.6–12.5); 1-vessel obstructive HR, 9.0 (95% CI, 4.2–19.0); 2-vessel obstructive HR, 16.5 (95% CI, 8.1–33.7); and 3-vessel or LM obstructive HR, 19.5 (95% CI, 9.9–38.2). One-year mortality rates were associated with increasing CAD extent, ranging from 1.38% among patients without apparent CAD to 4.30% with 3-vessel or LM obstructive CAD. After risk adjustment, there was no significant association between 1- or 2-vessel nonobstructive CAD and mortality, but there were significant associations with mortality for 3-vessel nonobstructive CAD (HR, 1.6; 95% CI, 1.1–2.5), 1-vessel obstructive CAD (HR, 1.9; 95% CI, 1.4–2.6), 2-vessel obstructive CAD (HR, 2.8; 95% CI, 2.1–3.7), and 3-vessel or LM obstructive CAD (HR, 3.4; 95% CI, 2.6–4.4). Similar associations were noted with the combined outcome.”

Nonobstructive Coronary Artery Disease and Risk of Myocardial Infarction - PMC

Little is known about cardiac adverse events among patients with nonobstructive coronary artery disease (CAD). To compare myocardial infarction (MI) and mortality rates between patients with nonobstructive CAD, obstructive CAD, and no apparent CAD ...

pmc.ncbi.nlm.nih.gov

So yes the risk is increased, but the baseline risk for any one person of having a heart attack over the course of a year is pretty damn low to begin with.

It’s also worth noting that study is about a decade old.

It’s also worth asking what harms will come from stopping diving. Depression, substance abuse, lack of exercise, isolation may all be far more risk than the baseline risk of ACS and the slight increase in that associated with diving. Doubly so when someone is fairly active with the CAD as a backdrop.

If a patient is comfortable with that risk, demonstrates they are able to be physically active without issues, are managed medically to the maximum tolerated/recommended, do not see why stable CAD alone should preclude someone from diving.

Nice to see someone actually citing good evidence! It's worth noting that MI mortality has dropped markedly with modern treatments (and I assume the OP is on a high dose statin now) and people are living to deal with longer-term consequences like CHF instead. I would be interested to hear if the DDM folks have any evidence/risk calculator for increased risk of ASCVD events while diving.

 

[pepperbelly]

Not on a statin. My cholesterol and triglycerides are in normal range and my hdl is good in range. Statin meds have been discussed and dr may put me on one.
Right now I am waiting to see my dr to discuss the results.
I posted here to get a feel for what may come up regarding diving. I understand that it all depends on what he says.