Scuba Diving and Coronary Artery Disease

[Add Helium]

A great article from Rebreather Instructor Dr. Doug Ebersole, on Scuba Diving and Coronary Artery Disease.

It is estimated that there are about 3 million certified scuba divers in the United States. A large number of these individuals are middle-aged or older and at risk for coronary artery disease. Cardiovascular disease is the third most common cause of death while diving and remains the principal cause of death in the general population. The development of symptoms of angina, pulmonary edema, or sudden cardiac death underwater carries with it a much higher mortality than would the same event on land. This article will review the workloads related to scuba diving, ways to assess risk in those with or at risk of developing coronary artery disease, and make recommendations to make scuba diving safer. Read more...

 

[CaveMD]

One thing to keep in mind, micro bubbles from decompression stress have been associated with increased platelet activation, to my knowledge there has never been a study evaluating the efficacy of aspirin/plavix/ticagrelor etc in the setting of decompression stress. This is a particular concern for patients post PCI w/ stents(especially recent ones) because of the potential for within stent re-thrombosis.

--This is all academic/theoretical, there have never been any studies to actually evaluate if the effect is statistically significant in this patient population--basically dive at your own risk(just an informed one)

 

[tracydr]

One thing to keep in mind, micro bubbles from decompression stress have been associated with increased platelet activation, to my knowledge there has never been a study evaluating the efficacy of aspirin/plavix/ticagrelor etc in the setting of decompression stress. This is a particular concern for patients post PCI w/ stents(especially recent ones) because of the potential for within stent re-thrombosis.

--This is all academic/theoretical, there have never been any studies to actually evaluate if the effect is statistically significant in this patient population--basically dive at your own risk(just an informed one)

Interesting thought. I have to go on Coumadin or xarelto after I get off lovenox for my osteonecrosis. I definitely had ptoblems with platelet activation after my last deep dive, causing me to have a huge problem with my osteonecrosis to get much,much worse than it already was. I apparently have had mild AVN,which I didn't know, but looking back, I've had these vague joint pains in my knees and ankles for the past 5 years, ever since I was treated with a huge dose of steroids. Then, I went diving on Catalina this spring and had what was probably a very mild DCS. Over the next few months, I went from having mild,intermittent joint pains to wheelchair.
Anyway, turns out that I have anticardiolipin antibody, along with another genetic factor putting me at risk for clots. I'll be on anticoagulation for life. When I miss even 6-8 hours of my lovenox, due to the pharmacy running out, or being held for surgery, I get severe joint pains.
Which is why I ask, if anything is known about Coumadin or xarelto ( hoping to use xarelto if its approved by tricare) and diving.

 

[flots am]

A great article from Rebreather Instructor Dr. Doug Ebersole, on Scuba Diving and Coronary Artery Disease.

It is estimated that there are about 3 million certified scuba divers in the United States. A large number of these individuals are middle-aged or older and at risk for coronary artery disease. Cardiovascular disease is the third most common cause of death while diving and remains the principal cause of death in the general population. The development of symptoms of angina, pulmonary edema, or sudden cardiac death underwater carries with it a much higher mortality than would the same event on land. This article will review the workloads related to scuba diving, ways to assess risk in those with or at risk of developing coronary artery disease, and make recommendations to make scuba diving safer. Read more...

Nice article!

I sort of thought it would be self-evident that divers should limit their exertion underwater to levels that are personally known-safe, but apparently it's not as evident as I thought.

The article's recommendation to use appropriate meds to control risk factors (BP/Cholesterol) would also seem to be a good idea regardless of whether the person is a diver or not.

When diving, I'd much rather have a known-healthy buddy who's taking meds and has well controlled BP/Cholesterol/etc or a buddy who knows and respects his limitations, than a 300 pound guy with a beet-red face who can hardly climb the ladder.

At 57, I can still hike and climb stairs and hills (assuming my joints are feeling up for it), however I make no pretext about being able to produce superhuman amounts of sustained aerobic activity underwater. If for some reason I find myself quite a bit down-current from the boat, I'll be exercising my "shoot the SMB and wait for pickup" muscles, not my "fin against the current for 15 minutes" muscles.

flots.

 

[TSandM]

I believe there have been some studies of aspirin as a preventative for DCS, and as part of the treatment, showing no benefit. I'm too lazy to go search Rubicon for them right now, though.

 

[agilis]

The likelihood of cardiac problems as we get older is an issue not limited to scuba. Airline pilots have strict age limits largely because of the statistics. Older drivers often die at the wheel, and sometimes take others with them. Older scuba divers who die from heart attacks almost never do any harm greater than creating negative publicity for the dive operation they may have been diving with. I see the wary, unwelcoming looks I get when an operator sees from my C card that I'm over 70.

I'm fond of life, so I don't do deep dives anymore, stay very very far away from DCLs, and avoid diving in strong currents or anything else likely to be strenuous. I have no problem with calling a dive if conditions are less than ideal. I prefer to dive alone, and always have. The issues of dying from something like a heart attack while diving give me added reasons to do so.

I have a Thallium stress test every two years, and cardiac/major blood vessel ultrasounds annually. They tell me my blood vessels are as clear as a bell, that I'm in much better shape than many 40 year olds, and that no one would guess my age from my appearance and the way I move, but the reality is that systems wear out and things happen. All any of us can do is maximize the odds in our favor. I'm damned if I'll give up diving, and there are worse ways to go.