Diving after a heart attack

[Duke Dive Medicine]

Hi Bill,

Returning to diving after a heart attack should be done in close consultation with your cardiologist and a diving medical physician. There are a lot of individual variables, e.g. anticoagulant therapy and level of function of the heart. We recommend that you be off of post-stent anticoagulant therapy before returning to diving due to the increased risk of bleeding from trauma. Also, if your cardiac function was not preserved (i.e. your ejection fraction was affected), you may be reasonably ok on the surface but at risk under water with intravascular fluid shifts. If you're near Seattle, I recommend you contact the hyperbaric unit at Virginia Mason and talk to Dr. Jim Holm.

For inspiration, you can read Eric Douglas' story. He's the former training director at DAN.

Books by Eric Douglas - Thriller fiction | Non-fiction: Adventure with a Purpose

Best regards,
DDM

 

[Rred]

Mr. Bill-
Call DAN, join DAN, get some opinions, read some of the articles they have online, see a "diving doctor", i.e. a cardiologist that also has dive training, if possible.
I'm guessing that with three stents you are also on at least one anti-coagulant, possibly Plavix and stronger? This class of drugs creates problems. While there are no absolutes, the issue is that diving can result in internal barotrauma, i.e. bleeding internally in the sinuses or inner ear or elsewhere. Normally this is a small bleed, like a paper cut, and it quickly clots and stops, no big deal.
If you are on anticoagulants of any kind, it MAY NOT STOP. And there's no way to put pressure on the wound, etc. because it is internal and out of reach. So you are bleeding, and possibly having trouble breathing because of that trickle, and you can't stop it. The answers are that you must dive very carefully, make sure you do not risk an internal bleed from not clearing, etc. And make sure that you and your party (divemaster, boat operator, whoever) know that IF you need a medevac for internal bleeding, the medevac crew need to know you are on anticoagulants. There are very few that are reversible (at high cost) but emergency rooms can and will give you transfusions of platelets or whole blood as needed--and they need to be aware of that, to set it up promptly.
"Don't ask how I know that." I'm not a doctor, this is not medical advice.
If you are not a MedicAlert member, I'd suggest joining. Then you get a stainless dogtag, put your emergency information on it (you can buy better one online) and the emergency personnel can call them to get your full medical history, contacts, etc.
I wouldn't say diving is in or out, you'll need the diving cardiologist to explore that. Just know that there IS a real and ongoing problem with divers and anticoagulants, you have to weigh that and make accommodation for it.

 

[Mr Bill]

Thanks every one. Im only on plavic and lipator. From what I have read about Plavic it is a anti platelet drug so clots do not form. I found a dive doctor and plan to see him next summer.. I am a member of DAN. Never had a problem clearing or bleeding when diving.

 

[Colliam7]

****************MOD POST****************

Two threads started by the same SB user have been merged. The topics are essentially the same, and merging the threads will allow for a m ore thorough discussion.

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[Rred]

Bill-
Apparently the problem is that Plavix permanently destroys platelets, and it can take the body something lime a month to completely replace them. So if you go off Plavix for a week (i.e. before a dental cleaning, your dentist needs to know about this too) you get 1/4 of the platelets replaced with new functional ones.
What Plavix does to them cannot be undone, so the treatment includes administering platelet-rich serum as opposed to whole blood. You'll find a large amount of information on the Plavix web site as well as those from reputable sources, i.e. NIH and the major hospitals.
Plavix may not turn you into a hemophiliac, but without compression on a wound, it will bleed way more than a normal person would. Don't wait until the summer--this affects everyday life. And there really aren't any "better" alternatives for most people, just ways to cope/compensate.
Lipitor, AFAIK, would have no issues for diving, other than the normal issues with Lipitor. (Fatigue, muscle pain, weakness...there are real complications for some folks.)
FWIW.

 

[Dan]

I had a heart attack 7 years and 350 dives ago due to 90% clogged in right coronary artery & got a stent. I'm taking 75mg Plavix & 40mg Simvastatin every day for the rest of my life. Took 6 months to recover. Changed my diets & doing more exercise, even hiked up Kilimanjaro 2 years ago. Broke my left Achilles tendon during sparring 3 years ago. Broke my right knee cap when I fell from 3rd to 2nd deck of a liveaboard 2 years ago, but still here, kicking & diving. Even feel 10 years younger since. So, I won't slow down, just be more careful of what I do, where I go & do plenty of warm up before hard exercise.

 

[DocVikingo]

Lipitor, AFAIK, would have no issues for diving, other than the normal issues with Lipitor. (Fatigue, muscle pain, weakness...there are real complications for some folks.) FWIW.

Hi Rred,

True, but it is important to note that symptoms like fatigue, muscle pain & weakness would not be confused with DCS in a non-diver or in a diver who has been topside for an extended period, but they easily could be so confused when they manifest during or shortly after a dive.

The person taking atorvastatin calcium will want to monitor for an adequate period of time for topside adverse reactions before diving.

Regards,

DocVikingo

 

[wetb4igetinthewater]

Dr. Edmond Kay (Doc's Diving Medicine Home Page) is now retired, as I understand it. But he may be able to refer you to another doctor.

 

[Rred]

Doc-
I wasn't talking about symptoms or problems that are diving related, but about problems that statins *will* cause in a significant number of users, right from the start, no diving needed. A friend of mine had significant muscle pains and weakness when put on statins, and the doctor immediately pulled them off that particular me. With some patients, the muscle weakness after taking statins is supposed to be a permanent problem--even if the drugs are discontinued.
No confusion with DCS, statins can make you feel like you made a forced march through the mountains, without any help from other things.

 

[JamesBon92007]

Doc-
I wasn't talking about symptoms or problems that are diving related, but about problems that statins *will* cause in a significant number of users, right from the start, no diving needed. A friend of mine had significant muscle pains and weakness when put on statins, and the doctor immediately pulled them off that particular me. .

Did your friend try Praluent? It supposedly affects very few people that way plus it can raise the "good" cholesterol.