Diving after bypass surgery

[agilis]

Sounds like the best possible outcome! What studies did they do afterward? Cardiac ultrasound, ECG, stress test?

Best regards,
DDM

All three. It was the surgeon who first told me there was no heart damage, confirmed by the cardiologist, along with my rapid recovery, to a point where I have a lot more energy and stamina than I did before the surgery. Before the bypass I had occasional dizziness, but that's gone. I had regarded various symptoms as age related issues, since I'm close to 80, but it was my coronary arteries all along.

 

[GQMedic]

Resurfacing a useful thread. I feel it’s handy.

I’m a long time diver and SCUBA instructor that has had a triple CABG *before* a heart attack.

I had been feeling very lethargic at work, and for quite some time (Police officer).

After reporting a few experiences with angina, my cardiologist had me come in for a CT with contrast and then an angiogram.


After recovering from the angiogram, I was informed of 9 blockages, 6 of which were greater than 90%, so,after meeting with a panel of cardiologists with a surgeon, it was decided that I would have 3 stents, AND a triple CABG.

Guys, get your heart checked before you have heart attack, like I did. It took a major open heart surgery, and some stents, and a radical lifestyle change, but I was pleased now two years post surgery, I’m back to diving again and teaching SCUBA again.

Actually, I view SCUBA as part of my regimen for living longer and better.

So, divers older than 50, get that here checked! Ask for an Angiogram to see if you’ve got blockages, and have them dealt without well before you have a heart attack.

Start eating smarter watch your blood sugar, get rest, drink more water, exercise daily, SCUBA as it turns out is good for your heart.

Of course, SEE YOUR DOCTOR, and be cleared to dive before hand, but once clear to dive, go do it. It’s keeping me young, and giving me the courage to eat smarter, drink more water, swim, ride a mountain bike, and I feel better now than I did when I was in my 20s.

Again, I’m telling ALL divers that if you’re over 50, gone your doctor, get checked out thoroughly! This has saved me from having a heart attack, and is keeping me diving, and diving is keeping me healthy and alive. It all seems to relate.

How many of my fellow divers
And instructors have had a CABG for prophylaxis of infarction?

 

[kinoons]

So, divers older than 50, get that here checked! Ask for an Angiogram to see if you’ve got blockages, and have them dealt without well before you have a heart attack.

Unfortunately this may not actually be helpful.

Depending on how acute (new) the blockages are, collateral (replacement) circulation does develop.

From a 2018 trial of PCI (heart cath) vs sham procedure

The results of the ORBITA trial (Objective Randomized Blinded Investigation with Optimal Medical Therapy of Angioplasty in Stable Angina) were presented at the Transcatheter Cardiovascular Therapeutics meeting in November and simultaneously published in the Lancet. Patients who received PCI did not perform significantly better than the control group on exercise time. It was the first time a sham-controlled arm has been used in a trial of PCI in stable angina despite the fact that more than half a million patients undergo the procedure worldwide each year, explained lead author Rasha Al-Lamee, MD, an interventional cardiologist at the National Heart & Lung Institute at Imperial College London.

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.033105

A follow on study that modified the original procedure did find benefits to PCI.

• PCI improved angina symptoms at 12 weeks vs. a sham procedure in patients with stable angina, ischemia and severe coronary stenosis.

https://www.healio.com/news/cardiology/20231111/pci-improves-angina-symptoms-vs-sham-procedure-in-patients-with-stable-cad-orbita2

A deeper analysis of the second trial’s data showed that being specific on who truly had angina made a difference in who improved; Non cardiac causes of chest pain (atypical angina) generally do not respond to PCI.

This isn’t intended to be an blanket statement about when someone should or shouldn’t get work done on their heart, but to instead demonstrate this is more complicated than just see blockage fix blockage.

The risk of looking with no symptoms is you can get roped into becoming a patient with none of the benefits of treatment and all the risk/cost associated with treatment.

The human body is fabulously more complex than we give ourselves credit for. Additionally our belief that a mechanistic approach must fix problems is often flat wrong.

 

[GQMedic]

Unfortunately this may not actually be helpful.

Depending on how acute (new) the blockages are, collateral (replacement) circulation does develop.

From a 2018 trial of PCI (heart cath) vs sham procedure

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.033105

A follow on study that modified the original procedure did find benefits to PCI.

https://www.healio.com/news/cardiology/20231111/pci-improves-angina-symptoms-vs-sham-procedure-in-patients-with-stable-cad-orbita2

A deeper analysis of the second trial’s data showed that being specific on who truly had angina made a difference in who improved; Non cardiac causes of chest pain (atypical angina) generally do not respond to PCI.

This isn’t intended to be an blanket statement about when someone should or shouldn’t get work done on their heart, but to instead demonstrate this is more complicated than just see blockage fix blockage.

The risk of looking with no symptoms is you can get roped into becoming a patient with none of the benefits of treatment and all the risk/cost associated with treatment.

The human body is fabulously more complex than we give ourselves credit for. Additionally our belief that a mechanistic approach must fix problems is often flat wrong.

I get what you’re saying, but finding arterial stenosis pre-infarction IMHO is a no-brainer be it diving suitability or simply living. Restoring as close to normal blood flow through the coronary artery prior to infarction, again makes an abundance of difference -v- a little too little too late.

For myself, not only was I very pleased that I prevented an early death from coronary artery stenosis, but being able to dive again is very little short of a miracle!

 

[kinoons]

I get what you’re saying, but finding arterial stenosis pre-infarction IMHO is a no-brainer be it diving suitability or simply living. Restoring as close to normal blood flow through the coronary artery prior to infarction, again makes an abundance of difference -v- a little too little too late.

For myself, not only was I very pleased that I prevented an early death from coronary artery stenosis, but being able to dive again is very little short of a miracle!

I understand your perspective. The problem is we will never know the counterpoint - if you and your physician never did anything what would have happened.

In your instance you were having symptoms, so it is plausible that PCI and bypass did extend your life. None the less we don’t know for sure.

Multiple studies have not shown a significant benefit of PCI over medical therapy for asymptomatic CAD

We need to avoid the “therapeutic illusion” that we are accomplishing more than is shown by the evidence.40 Percutaneous coronary intervention for stable patients remains principally a treatment of limited benefit for angina, and probably no benefit for asymptomatic patients.

Reexamining the Efficacy and Value of Percutaneous Coronary Intervention for Patients With Stable Ischemic Heart Disease

Percutaneous coronary intervention (PCI) continues to be performed frequently for patients with stable ischemic heart disease, despite uncertain efficacy. Individual randomized trial data and meta-analyses have not demonstrated that PCI in addition to ...

www.ncbi.nlm.nih.gov

Let’s use screening mamograms as another example. Over the last thirty years the number of small masses found thanks to mammograms has greatly increased. OTOH the number of large masses has remained dead constant inspite of all the treatment of small masses. Dr. Vinay Prasad argues this is the hallmark of overtreatment. He makes his case here.

Mammography - everything you need to know

The USPSTF is changing their recommendations to once again push mammography to younger women. I know many of you dislike videos, but I promise this is worth your time. I go through a slide deck on mammography and combine the studies with my interpretation. If you are at all interested in...

www.sensible-med.com

Again, the human body is immensely complex. This is why mechanistic theories still must be proven to be correct before adopted. It is also why you cannot generalize one success (PCI in the setting of a unstable CAD) to another very similar, but distinctly different patient population (stable CAD).