Heart Stint and diving
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Hi Ron..gr8fulr2:
Maybe a real doctor can help you with this one but I can tell you what I've been personally told by my own doctor. I'll be having a full arterial bypass in a couple of weeks - iliac/aortic not heart. I've been told that I should be OK to dive afterwards in about 3 months. At first they also thought I might need some stenting in my heart as well although luckily that proved to be not necessary. Even if it had been though nobody suggested it would affect my future diving after recovery. You should most certainly not take anyone's word on this though and consult a specialist in cardio-vascular/cardio surgery.
When I was diagnosed as having blockages though it was the first thing I asked!
Best of luck to you...
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Hi gr8fulr2,
Hopefully the surgeon did not stint on the stents.
As "Vald the Impailer ;0" has stated, the device under discussion is termed a "stent" http://www2.merriam-webster.com/cgi-bin/mwmednlm?book=Medical&va=stent
My take on the issue is that before consideration of return to scuba following stent insertion for coronary artery blockage a diver would need to be fully recovered from the placement procedure, and have normal blood flow with a stress test at high METs (e.g., Stage 4 Bruce protocol) showing no electrocardiographic abnormalities, shortness of breath or chest pain. S/he would also be advised to wait a sufficient period to assess for the likelihood of restenosis. After these have been achieved, the diver and his or her doctor can sit down and address the issue of fitness to dive.
Here are the more detailed opinions of two recognized authorities:
"Jan 26, 2006
Ern Campbell, MD
At the present time, the most likely reason for a diver over the age of 40 to die suddenly while diving is a heart attack with an accompanying fatal heart rhythm. Patients who have had successful coronary bypass surgery, angioplasty or stents who wish to resume sport diving should generally be allowed to participate in this activity.
However, commercial, military or civic divers probably should not be allowed to continue diving due to the increased physical and mental stress of the dives. There is a high rate of re-stenosis after angioplasty [30%] and stenting [20%], usually within 6 months.
Within the limits of the brief history that you provide, the diver should be able to resume sport diving with a normal thallium exercise test. In deciding whether to dive, there should be a careful periodic review of coronary anatomy and degree of vascularization. An exercise tolerance (exercise test) study should be undertaken. If they can exercise with no ischemia (decreased blood supply), or angina (chest pain), normal blood pressure response, and no serious heart irregularity (arrhythmia), limited sport diving may be considered. Limited sport diving involves warm water ( 3 mm wet suit ), shallow depths ( 60 fsw/18.3 m. ) and minimal currents with easy entry and exits.
The diver will need to keep his weight and blood pressure under control and maintain an exercise program and attempt to reduce as many risk factors as possible. His cardiologist should be the final arbiter in making the decision as to whether or not they may return to diving.
Another similar but slightly different set of guidelines is set forth by Dr. Omar Sanchez, Argentinan cardiologist /diving instructor. People who have had angiography and stents can return to diving but should have fulfilled the following guidelines. This is most often an individual call made by your physician and cannot be strictly delineated.
---They were an established diver prior to their coronary revascularization.
---They have no cardiac symptoms when off all cardiac medication (although lipid lowering drugs
and antiplatelet agents are permitted).
---They can perform satisfactorily a treadmill exercise test, achieving a good workload (for age,
sex and build), with a normal heart rate and blood pressure response without evidence of
ischemia on a 12 lead ECG. This usually means 4-5 on the Bruce scale or attaining 13 METS.
Discuss this with your doctor as this is associated with rather heavy exercise.
---There is little residual myocardial dysfunction (particularly a preserved left ventricular ejection
fraction).
---They must dive with experienced companions who can render assistance if required. ---Fitness
to dive should be reviewed annually irrespective of the diver's age, but should symptoms recur
between medical examinations, the diver must cease diving until reviewed."
Helpful?
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such. Questions about diving and coronary artery disease are best discussed with a diving medicine savvy cardiologist.
Regards,
DocVikingo
Hopefully the surgeon did not stint on the stents.
As "Vald the Impailer ;0" has stated, the device under discussion is termed a "stent" http://www2.merriam-webster.com/cgi-bin/mwmednlm?book=Medical&va=stent
My take on the issue is that before consideration of return to scuba following stent insertion for coronary artery blockage a diver would need to be fully recovered from the placement procedure, and have normal blood flow with a stress test at high METs (e.g., Stage 4 Bruce protocol) showing no electrocardiographic abnormalities, shortness of breath or chest pain. S/he would also be advised to wait a sufficient period to assess for the likelihood of restenosis. After these have been achieved, the diver and his or her doctor can sit down and address the issue of fitness to dive.
Here are the more detailed opinions of two recognized authorities:
"Jan 26, 2006
Ern Campbell, MD
At the present time, the most likely reason for a diver over the age of 40 to die suddenly while diving is a heart attack with an accompanying fatal heart rhythm. Patients who have had successful coronary bypass surgery, angioplasty or stents who wish to resume sport diving should generally be allowed to participate in this activity.
However, commercial, military or civic divers probably should not be allowed to continue diving due to the increased physical and mental stress of the dives. There is a high rate of re-stenosis after angioplasty [30%] and stenting [20%], usually within 6 months.
Within the limits of the brief history that you provide, the diver should be able to resume sport diving with a normal thallium exercise test. In deciding whether to dive, there should be a careful periodic review of coronary anatomy and degree of vascularization. An exercise tolerance (exercise test) study should be undertaken. If they can exercise with no ischemia (decreased blood supply), or angina (chest pain), normal blood pressure response, and no serious heart irregularity (arrhythmia), limited sport diving may be considered. Limited sport diving involves warm water ( 3 mm wet suit ), shallow depths ( 60 fsw/18.3 m. ) and minimal currents with easy entry and exits.
The diver will need to keep his weight and blood pressure under control and maintain an exercise program and attempt to reduce as many risk factors as possible. His cardiologist should be the final arbiter in making the decision as to whether or not they may return to diving.
Another similar but slightly different set of guidelines is set forth by Dr. Omar Sanchez, Argentinan cardiologist /diving instructor. People who have had angiography and stents can return to diving but should have fulfilled the following guidelines. This is most often an individual call made by your physician and cannot be strictly delineated.
---They were an established diver prior to their coronary revascularization.
---They have no cardiac symptoms when off all cardiac medication (although lipid lowering drugs
and antiplatelet agents are permitted).
---They can perform satisfactorily a treadmill exercise test, achieving a good workload (for age,
sex and build), with a normal heart rate and blood pressure response without evidence of
ischemia on a 12 lead ECG. This usually means 4-5 on the Bruce scale or attaining 13 METS.
Discuss this with your doctor as this is associated with rather heavy exercise.
---There is little residual myocardial dysfunction (particularly a preserved left ventricular ejection
fraction).
---They must dive with experienced companions who can render assistance if required. ---Fitness
to dive should be reviewed annually irrespective of the diver's age, but should symptoms recur
between medical examinations, the diver must cease diving until reviewed."
Helpful?
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such. Questions about diving and coronary artery disease are best discussed with a diving medicine savvy cardiologist.
Regards,
DocVikingo
WilDive4Food
Registered
I have a similar inquiry in this as I am trying to get my wife into diving. She has had a quad by-pass 3 yrs ago and I have wondered if it would cause problems. The physical exertion isn't a problem as she does quite a bit of that each day on her job. The question in my mind is how much her meds might affect her, blood thinners, blood pressure, etc...
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Hi gr8fulr2,
You're welcome and I hope you found the info of value.
Yes, it's a good thing to know both the meanings and spellings of medical conditions, procedures and devices that directly affect your health and life.
One quick example of this importance can be found in the most recent and just released Institute of Medicine (IOM) study of medication errors, e.g., "Drug mistakes hurt 1.5 million yearly-Hospital patients can expect an error a day"
http://www.chicagotribune.com/news/...,1,6770855.story?coll=chi-newsnationworld-hed
A number of these mistakes are the direct result of illegibility, misspellings, confusion over spellings/drug names, a general lack of information and simply not paying attention.
Regards,
DocVikingo
You're welcome and I hope you found the info of value.
Yes, it's a good thing to know both the meanings and spellings of medical conditions, procedures and devices that directly affect your health and life.
One quick example of this importance can be found in the most recent and just released Institute of Medicine (IOM) study of medication errors, e.g., "Drug mistakes hurt 1.5 million yearly-Hospital patients can expect an error a day"
http://www.chicagotribune.com/news/...,1,6770855.story?coll=chi-newsnationworld-hed
A number of these mistakes are the direct result of illegibility, misspellings, confusion over spellings/drug names, a general lack of information and simply not paying attention.
Regards,
DocVikingo
Sorry I missed this discussion the last couple of days, but I've been off diving. I'm one of the cardiologist members on Scubaboard with an interest in diving medicine. The info given above was great. While Fred Bove, MD is clearly "The Guy" when it comes to fitness to dive, especially with cardiology issues (he's a cardiologist as well), this is my summary of the literature.
After stenting or bypass surgery you can return to diving if you have normal heart muscle function and no evidence of ischemia (limitation of blood flow to the heart) with exercising to 13 mets (12 minutes on a standard Bruce treadmill test). The caveat is that after surgery you must wait until all of the wounds have healed and for stenting you need to wait 6 months to make sure the stent is not going to renarrow (if they haven't by then, it is very unlikely they will in the future). Also, while not truly required I would also recommend annual stress testing to make sure there has not been progression of underlying disease, failure of bypass grafts, etc. Just my 2 cents.
After stenting or bypass surgery you can return to diving if you have normal heart muscle function and no evidence of ischemia (limitation of blood flow to the heart) with exercising to 13 mets (12 minutes on a standard Bruce treadmill test). The caveat is that after surgery you must wait until all of the wounds have healed and for stenting you need to wait 6 months to make sure the stent is not going to renarrow (if they haven't by then, it is very unlikely they will in the future). Also, while not truly required I would also recommend annual stress testing to make sure there has not been progression of underlying disease, failure of bypass grafts, etc. Just my 2 cents.
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