Looking for Cardiac Education

[odblnt]

And maybe a little encouragement & reassurance.

First off, I am a 64 year old (retired) male who was out of diving for over 20 years. I got back into it almost 2 years ago and went from refresher through AOW and a bunch of specialties until an instructor friend suggested that I think about DM. Once I found out the physical requirements, I started hitting my local YMCA pool and knocking off running (one of my knees was giving me problems anyway). At that time my weight was over 225 and I was on Lisinopril and Simvastatin. I did have my doctor do a medical clearance before I started diving and had it updated with every checkup.

Anyway, with all that swimming and some other small lifestyle changes, I managed to drop over 30 pounds in 18 months and my doctor recently took me off my meds after reducing them gradually. I also did my DM as well as IDC and have been instructing since July (and having a great time doing it). When I'm not on the dive boat or in the pool with students, I do my regular thing at the Y - either 45 minutes straight crawl or 30 minutes crawl and 30 minutes mask/fin/snorkel. I usually do my DM 400 yd swim at the end of my sessions and average between 9:00 to 9:15.

My internist noticed a slight murmur so referred me for an echo cardiogram where they discovered an aortic valve stenosis / biscuspid aortic valve and now I'm just waiting for the cardiologist referral. My internist OK'd swimming in the pool as well as scuba in the pool (so I could still do academic and confined OW skills) but has drawn the line at open water until we see what the cardiologist has to say. I sent an inquiry to DAN, and there are no local diving cardiologists, but the chief of the heart center is active in surfing and other water sports, so I am in hopes that they are fairly knowledgeable.

What I guess I want to know is what I should be expecting for this referral as well as what my chances of returning to the open water are (either personal diving or instructing)? Also, what questions should I be asking? DAN e-mailed me the Bove & Davis Diving Medicine chapter on cardiovascular disorders and diving to give to the cardiologist with an offer for the doc to call them with any questions. In reading through this chapter on my own, it looks like things could go either way. On the plus side, I am in pretty good shape now (in spite of my valve). On the minus side, I'm just not sure.

At this point, I'm really kicking myself for not getting back into diving earlier! :depressed:

Any help/education/encouragement would be appreciated.

 

[tracydr]

It really depends on the severity of the stenosis. It may require valve replacement or they may choose to watch it. I suspect it's not too severe, given the amount of exercise you're tolerating. But, it really depends on the echo, EKG, chest x-ray and stress test.

 

[Duke Dive Medicine]

Hi Pete,

Here's a recent thread on the subject that may be helpful:

http://www.scubaboard.com/forums/diving-medicine/365633-bicuspid-valve-aortic-root-dilation.html

Congratulations on getting back into shape. Your cardiologist can also consult us at any time. Our clinic number and 24-hour contact info are on the website linked below.

Best regards,
DDM

 

[odblnt]

Thanks for the replies. Cardiologist's office called the other day and set my appointment for 6 December. :depressed:

Lots more swimming laps and pool diving until I get to see him.

 

[odblnt]

Saw the cardiologist. He said that the stenosis was moderate. Slight would have been OK for diving, severe would have been no diving. He admitted he wasn't sure. I asked if he wanted a copy of the chapter on diving physiology that DAN sent me, and he recognized the author and asked for me to e-mail the pdf to him. He also scheduled a stress-EKG (treadmill). No surprise there.

I did the treadmill on Monday and will find out my fate on Thursday.

 

[odblnt]

I did the treadmill and finished it off in the "superior" range with no real problems. When I went back to see the cardiologist, though, he said that in reading the article from DAN, they say no diving when the aortic valve reaches 2.5 cm² and since mine was already at 1.4 cm² he was cutting me off. He said that he discussed it with his colleagues and they were in agreement, but he would have no problem if I wanted to look for a second opinion. He didn't even want me on scuba gear in the pool (which kills my 3-Day OWs).

I am continuing to swim laps at the YMCA and figure that when I start noticing my lap times extending or finding myself getting winded, then I will get concerned. Oh, and I'm supposed to go back every year for an echo to see how the stenosis is progressing.

So much for one of the shorter dive instructor careers on record. Now if I could only find a cardiology resident who wants to do a scuba diving valve study on an otherwise fit specimen, then I could have fun. (I suspect that Bove's recommendation of 2.5 cm² was not based on someone of my fitness level. Probably more the "40 pounds overweight" kind of person.) Until then, I'm just waiting for my valve to close up enough for them to justify the surgery.