Dilated Cardiomyopathy and Atrial Fibrillation

[Scubapro146]

Dear Dr. Decompression,

You may remember me from the beginning of June when I posted a thread about being diagnosed with Dilated Cardiomyopathy, A-Fib and Congestive Heart failure. After 3 months of being on Altace, Amiodarone, Coumidin, Toprol & Digoxin, my Cardiologist had me go in for a Cardioversion. One shock with the paddles was all it took to put my heart back in the correct rhythm. After that and some tests, my Cardiologist took me off all the meds except for 6mg of Coumidin daily and 25mg of Toprol daily. I have since then had a follow up Echo Cardiogram which showed everything is back to normal. My Cardiologist just cleared me to dive again with no restrictions.

However, I am a tad concerned about still being on the Coumidin. I have heard opinions from others that diving on Coumidin is not a good idea. Even though (knock on wood) I have never had a problem with nosebleeds.
Anyhow, I am going to take it easy, maybe just do some pool dives to get my fins wet until I go to Puerto Rico in March. I am hoping to be off the Coumidin by then.

Any advice and opinions would be appreciated!

Tanks

 

[rawls]

Scubapro146...
I guess if your Dr cleared you then he or she feels your heart can handle it. The Afib can recur and the CHF is a definite concern. It would be interesting to know what your ejection fraction is. Did it decrease secondary to the CHF? If so, how much? The concern I would have would be the exertion diving requires. Are you exercising? How is your tolerance? But the possibility of over exertion and CHF would concern me...Is your Dr very knowledgeable about scuba?
There is a current thread about Coumadin on this forum.

 

[Dr Deco]

Hi Scubapro 146:

I am glad to hear that you are doing better. I personally, however, only answer questions concerning the physiology of decompression. Possibly posting this concern on the Scuba and Medicine forum would be better.

 

[fisherdvm]

I think in an ideal dive - no surf, no current, no waves - you might be fine. However, I would be hesitant to clear someone with Afib, history of congestive heart failure, and now treated dilated cardiomyopathy for any scuba diving.

If you are fighting current to get back to your dive boat, that might just be enough adrenalin for your heart to go out of rhythm. And if you have a little clogging of those arteries - it might be enough to send you into heart attack.

Dr. Deco can probably comment a little more on the coumadin aspect... But my fear of air emboli or nitrogen toxicosis is that they can translate into a hemorrhagic stroke.

If you want to dive, I would say, go only on the calmest day, and only in water with minimal or little current.

I don't know what's worse, diving with coumadin, or suffering stroke from Afib caused by the stress of diving without coumadin....

 

[cjgbur]

If your LV function (ejection fraction) is normal and you have been cleared to dive, then it should not be a problem. I personally would have you do the standard exercise treadmill test and make sure you can do the required workload (10 mets).

Coumadin is a different issue. It will not neccesarily prohibit you from diving, but you are at an increased risk of bleeding. You need to discuss these risk with your cardiologist and/or a physician that really understands diving and diving medicine. Then it's your decision if you accept the risk.