So do we need to warn against diving on beta blockers?

[DandyDon]

It seems like they are involved on IPE hits? http://www.scubaboard.com/forums/ne...call;-glad-i-could-write-incident-report.html

Or are there current warnings already out...??

 

[InTheDrink]

Hi Don.

Ultimately the jury is out as many middle aged men have both elevated BP and also may take beta blockers.

That said, my feeling is that they are best avoided for diving. I believe (but don't know any detail) that there is another family of beta blocker type drugs (ACE Inhibitors???) that aren't considered problematic for diving but I REALLY don't know about any of this so please no-one take it at face value.

Major take away for me is that a) where possible all medications should be avoided b) tell ppl what meds you're on and c) find out if your meds may put you at risk.

And don't ask your GP, it needs to be a dive physician.

But for the time being I would certainly suggest to avoid beta blockers and diving. But given I'm not a med my opinion is probably worth jack.

J

 

[68raggtop]

I'm taking a calcium channel blocker and it has worked well for me. I had talked to my Physician about it and he was perfectly willing to try that first. From what I read on the Dan website, it looked like a safer option.YMMV
Dave

 

[TSandM]

The mechanisms behind IPE are far from understood. There is an association with hypertension (for which beta blockers are often prescribed) but IPE has occurred in completely healthy people who have no medical problems and are on no medications at all.

Beta blockers are not the ideal blood pressure medication for a diver, because they can affect maximal exercise tolerance, which might be important if one had to swim against current, for example. But some people don't tolerate ACE inhibitors or for other reasons are better candidates for beta blockade.

 

[DandyDon]

I'm taking a calcium channel blocker and it has worked well for me. I had talked to my Physician about it and he was perfectly willing to try that first. From what I read on the Dan website, it looked like a safer option.YMMV
Dave

Thanks, good to know DAN has info. Always good to check. The discussion about the meds is continuing on the Accident thread and I thought it may help to bring the last three quotes over here...

Couple of comments on beta blockers and on blood thinners.

Beta blockers work by 2 routes. #1 they reduce the ability of the heart to beat faster - decreasing the workload and oxygen demand of the heart (negative chronotrope). #2 they reduce the ability of the heart to beat forcefully - again decreasing the workload and oxygen demand of the heart and the blood pressure in the system (negative inotrope). They are effective medicines, but do prevent increasing oxygen delivery under higher physical workloads. In plain English, they significantly decrease exercise tolerance.

Blood thinners for atrial fibrillation: The heart is 2 separate pumps side by side; one pumps blood to the body (left side) and the other pumps blood to the lungs (right side). Each pump has 2 chambers; the atria - helps fill the ventricles; and the ventricles - pumps the blood into the respective circulations. Fibrillation is a ineffective quivering of the chamber and pumps no blood. If the ventricle fibrillates, then the person dies without immediate treatment. This is the most common cause of cardiac arrest. If the atria fibrillates, not much happens unless the whole heart beats too fast. People live normal lives with the atria in constant fibrillation (atrial fibrillation or a.fib for short). A.fib has 2 dangers. First is the entire heart beating too fast. This is where the beta blockers come in. They are used for heart rate control. The second danger is having a blood clot or clots form in the poorly emptying atria. Since the blood in the atria isn't emptying well, it stagnates. Stagnant blood tends to clot. Clots in the heart are then sent out to either the lungs or the body (including the brain). A clot in the lung can cause death with a pulmonary embolus (prevents oxygenation of the blood) or a clot to the brain causes a stroke. How much damage depends on the size of the clot and where it lodges. Blood thinners (coumadin, warfarin) are used to reduce the risk of a blood clot. They have their own dangers - but not really and issue here.

As for Barracuda2's question: 3 episodes in 7 years, I can see his doctor advising either way. But blood thinners by themselves shouldn't change his exercise tolerance. Beta blockers certainly can.

And they surly did affect my exercise tolerance. Sometimes I could barely get into an exercise routine and my heart would start skipping. It makes sense to me that I could conclude easily that my IEP hit can be connected to the Beta Blocker I was on at the time; at the least, a contributing factor. My heart was not working efficiently for the activity I was doing; thus, a chain reaction starts in my body that ends up with me sucking air like a fish out of his element. I have stopped the Atenolol and have recently taken myself off the Flecanine Acetate. I can already notice the difference in the way my chest feels, my heart feels (no more random erratic heart beats); and my overall general physical being. Maybe the dive docs need to take a closer look at this; it could save a life.

I don't think many ppl properly appreciate the impact meds can have when diving unless something happens and then they appreciate it in a fairly large way.

I can't iterate enough that of you're on any meds get them cleared by a dive physician. And your GP is not a dive physician.

 

[Duke Dive Medicine]

Don,

This is such a broad category that I'd be hesitant to make any general warnings like that. Like most medications, we look just as hard at the reason the individual is on the drug as we do the drug itself. Does the person have hypertension that's refractory to first-line treatment, or is the drug primarily for control of heart rate in chronic atrial fibrillation? Either of these could be contraindications to diving in and of themselves.

Best regards,
DDM