Svt/psvt

[nagual]

Just had an SVT episode and needed to be cardioverted with Diltiazem in the ER. Have a trip planned to Indonesia in next few days for a week of diving. Is there any reason I should cancel it??

ms

 

[TSandM]

Oh, man . . . This is going to be a risk assessment situation. Unless there was a very identifiable cause of your arrhythmia (like amphetamine use, or some arrhythmogenic medication) you are at risk for a recurrence. Worse, the underlying problem that gave rise to the arrhythmia has not been identified or treated, and it could be ischemic heart disease (you don't give your age or any other personal information, so I can't know how likely that is). "Heart attack" is a sadly common cause of death in divers, and although tachydysrhythmias can certainly occur in hearts without any arterial disease, they can also be a warning of ischemia.

As much as I hate to give this advice, I would strongly urge you not to dive again until your problem has been completely worked up, and preferably solved. Having an arrhythmia or a heart attack underwater in Indonesia is not something you want to have happen, I don't think.

 

[Dr. Doug Ebersole]

The situation is not quite that simple. What is your age? Do you have a history of PSVT? If so, how often do they occur? If not, what evaluation did they do after your ER visit? What other medical conditions do you have? Have you been trained in various vagal maneuvers to terminate the tachycardia and have you used them in the past? Has the rhythm been evaluated in the past? Usually, PSVT is a benign rhythm associated with a structurally normal heart but not always. Unfortunately, you have a trip planned soon and it's a long way from state of the art medical care. You should really discuss your particluar situation with your doctor and, preferably, a cardiologist with some knowledge of diving medicine. Your avatar doesn't say where you're from but DAN could probably help get you referred. Also, I'd be happy to discuss things with you (I'm a cardiologist). PM me with your contact info if you'd like.

 

[-Phoenix-]

After reading this thread I started to wonder, perhaps you can answer my question debersole;

A good way to end a SVT in most patients is the use of the valsalva maneuver. When you dive and clear your ears, you will also perform this maneuver. So isn't it possible to say that its less likely you will get SVT while diving?

Yours,
Rob

 

[TSandM]

I don't know what debersole will say, but my track record on getting patients to break SVT with Valsalva, to date, is nil. Of course, I probably only see the people who haven't managed to do it at home . . .

 

[Dr. Doug Ebersole]

Valsalva works for some people but it normally takes a prolonged effort not the short Valsalva to clear your ears. Also, it is used to "break" SVT, not prevent it so diving and clearing your ears won't decrease it's occurrence. There some increased vagal tone from the mammalian diving reflex so maybe that comes into play, but I wouldn't count on it!