heart stints

[DocVikingo]

Hi D_I Guy,

This should get you started:

Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups
http://circ.ahajournals.org/cgi/content/full/98/16/1622

Regards,

DocVikingo

 

[DI_Guy]

Hi D_I Guy,

This should get you started:

Use of a Prognostic Treadmill Score in Identifying Diagnostic Coronary Disease Subgroups
http://circ.ahajournals.org/cgi/content/full/98/16/1622

Regards,

DocVikingo

Thanks for the web link, DocVikingo. It's very informative...

 

[fisherdvm]

I kinda view alot of these discussion like the epileptic patient who has a seizure once every 5 or 6 years. No one want to take his/her driver license away, yet, you see tonnes of these folks who still drives...

I see a scuba diver with coronary artery disease alot safer to myself and the community than half of the drivers on the road already - text messaging and blabbing to their friends with one hand on the wheel.

Eventually, you'll get hit with another MI, its a matter of when and how...

 

[DocVikingo]

I kinda view alot of these discussion (sic) like the epileptic patient who has a seizure once every 5 or 6 years. No one want (sic) to take his/her driver license away, yet, you see tonnes of these folks who still drives (sic)...

Hi fisherdvm,

Yes, they're still driving because no one has taken their licenses away. Am I missing the implication of the "yet" in your sentence?

Thanks,

DocVikingo

 

[fisherdvm]

Hi fisherdvm,

Yes, they're still driving because no one has taken their licenses away. Am I missing the implication of the "yet" in your sentence?

Thanks,

DocVikingo

The sad part is, there is no mandates for physicians to report them, like child abuse. Therefore, most of us, if not all, will not push to have to licenses revoked. I just tell them, you should not drive.... Then you would have the comment, "are you going to support my 5 kids, and take me to work comment."

I have never pushed for anyone to lose their license because of epilepsy, I leave it up to their neurologists...

 

[hundermunder]

This is good topic for me. I am an experienced diver and unfortunately had to undergo a triple bypass. Thank God no heart damage. Through meds, diet and excersize lipid levels are under control and good. So I called DAN and asked them about my condition and the med tech told me that I should be able to do a stress test with a MET of 6. I pointed out that all official documentation indicates a MET 13. He indicated that DAN and the associated doctor have received much flak over that number due to it being unrealistic. So, if a MET of 6 is more realistic why don't the physicians published guidelines change to reflect that new number? As you can tell I really want to get back in the water.

 

[Dr. Doug Ebersole]

The "13 met" rule came from Dr. Fred Bove, a very well respected cardiologist and expert on diving medicine. It is based on exercise physiology. Actually, I discussed this at length with Fred last April at the DAN Fatality Conference in Durham as I also had spent years recommending patients be able to go to 13 mets before returning to diving.

Here is where that recommendation and now the lower number came from. As treadmill testing is usually done by incrementally increasing the workload, we strive for a maximum exercise tolerance. The bottom line without going into the physiology is that if you can hit 13 mets on a treadmill (12 min on a standard Bruce protocol) as a maximum, that would suggest you could SUSTAIN an effort of around 6.5 mets for a prolonged period of time (say 20 min) which is what it would require for you to, say, swim against a significant current in the event you were downcurrent of the boat, etc. Another way to assess this rather than formal exercise testing would be to say that if a patient after stents or bypass surgery can walk 2 miles in 24 min (12 min miles) they are okay to return to diving as this is also a workload of around 6.0 - 6.5 mets. So they are really saying the same thing -- a MaXIMAL effort of 13 mets or a SUSTAINED effort of 6.5 mets to return to diving. Does that help?

Doug

 

[hundermunder]

Yes. Thanks for the clarification.

 

[Duke Dive Medicine]

Hundermunder,
This response took a while because we wanted to get consensus from all of our attending physicians.
First, thanks much to Doug for the very clear, concise summary of exercise tolerance testing and Dr. Bove's recommendations. We were also represented at the fatality conference and have recently revisited the recommendations that were made there.
Return-to-diving recommendations for cardiac patients are highly individual. In general, we recommend waiting one year after UNCOMPLICATED surgical intervention (stent placement, CABG) before considering return to diving. After one year, if there are no arrhythmias or heart failure, it's ok to resume diving within the limits of your existing exercise tolerance.
This is to be done in close consultation with your cardiologist. There are too many factors involved to make individual recommendations over the internet, but we will gladly consult with your cardiologist if he or she has any questions related to diving.
Best regards,
DDM

 

[hundermunder]

A tremendous thankyou from me to the dive medical community.