PVC concerns

[jbd]

At what point are PVC's(premature ventricular contractions) a problem for diving? My EKG report says;

1. Sinus rhythm rate of 61

2. Isolated PVC

3. Borderline voltage criteria for left ventricular hypertrophy.

I tried ScubaDocs website but couldn't find anything about PVC's.

 

[BillP]

Howdy jbd:

According to Alfred Bove in Bove and Davis' Diving Medicine isolated PVC's on an EKG can be found in normal people with no heart disease. Still, he believes divers with PVC's should have their EKG's assessed during exercise. He looks for PVC's that demonstrate a multifocal pattern (originate from different areas of the heart), show R-on-T phenonmenon (a worrisome place where PVC's sometimes show up on the EKG), or frequent coupling of sequential premature beats (having some or several PVC's in a row) as reasons to disqualify someone from diving. He also feels that people with compromised left ventricular function (the main pumping chamber of the heart) are at increased risk. Significant left ventricular hypertrophy might suggest compromised left ventricular function.

Much more than an EKG goes into assessing someone's cardiovascular risk with diving. Hopefully the diver's personal physician will be able to take the history, physical exam, and appropriate diagnostic tests and put them together for a recommendation- perhaps with DAN's help.

HTH,

Bill

The above is intended for discussion purposes only and is not meant as specific medical advice for any individual.

 

[jbd]

and I will add that echocardiogram indicates "concentric left ventricular hypertrophy with normal contractility". The measurements are at the upper end of normal.

The chest x-ray "reveal heart size that is at the upper limit of normal.

I have no symptoms of heart problems and can, through walking and running uphill, get my heart rate well over 160 for 20 to 25 minutes without experiencing any symptoms.

I have been diving since 1994 without problems however a doctor wants me to stop diving based on the isolated PVC without anymore investigation ie the stress test.

I have an appointment with a FAA qualified doctor(recommended by my training agency) this afternoon. I will relay your comments to him.

Thanks again

jbd

 

[John Reinertson]

In addition to the quote from Bove and Davis that BillP included, I can add that most Iowa cardiologists ( and a lot of sports medicine and cardiac physiology literature) recommend Exercise stress testing with treadmill or similar if there's concern about PVC's.

Isolated PVC's that occur at rest and disappear or diminish with exercise have been found in good studies to have no prognostic significance for risk of heart disease or serious arrhythmia.

(doctor-ese for they don't mean anything)

If the PVC's worsen with exercise, or other arrhythmias occur with a stress test, there is a distinct increased likelihood of arrhythmia or heart disease.
(Doctor-ese for time to talk with a real expert)

If they don't change with exercise, you are left with a big fat unknown.

The presence on echocardiogram of criteria for Left Ventricular Hypertrophy can occur in people who are athletic, particularly in serious weight lifters, but is a bit concerning overall.

It sounds like you're heading for a good workup and appropriate exam. Good luck, and we'll hope to see you in bubble country.
John

 

[jbd]

to the medical regulators who provided information! I'm cleared to continue traveling to "bubble country" to borrow a phrase from John Reinerston.

Finally I have officially started my assitant instructor course!

Thanks again!!