What Heart Condition...

[terrydarc]

...would prevent you from Scuba? I ran into a woman last night at a meeting who said she was going to Mexico about the same time we were, but wouldn't be diving because she had a heart condition. She gets to snorkel, so it's got to be something with pressure.

That set me wondering. What sort of condition could you have that would keep you out of the water as a diver? This woman appears very healthy, probably 30- years old. I'm certainly not going to tell her the doc is maybe overcautious and to go get a 2nd opinion, but it crossed my mind given that most GP's wouldn't know a scuba risk if they saw it.
=Terry

 

[wetvet]

There are plenty of defects that would prevent you from scuba diving....
1)arrythmias can cause poor oxygen distribution, and could cause vertigo or dizziness....not a big problem necessarily on land, but at depth could be a problem.
2) PFO (Patent Foramen Ovale), is a hole between the atria of the heart (the 2 smaller chambers). This hole is normal in fetuses, and normally closes at or near birth, but in a significant portion of the population (approaching 30%, I believe), it doesnt close. If you cough, or equalize hard, you can cause blood to shunt from the right to the left side.....this means that the blood has already picked up nitrogen from the tissues, and goes back around, without going thru the lungs to release the Nitrogen load....This can lead to bubble formation and aneurism, even if following "safe" proceedures.
3) Any defect that keeps blood-flow reduced to any part of the body will cause nitrogen to be eliminated unevenly, which will raise the risk of DCS.

I personally have a heart defect, and went out of my way to find a cardiologist that was familiar with diving (his office is 3hrs away), so that I could discuss with him what my risks are. I felt that many cardiologists (or MDs for that matter) who aren't familiar with diving would give a "knee-jerk" response of "dont do it" to anyone with a heart problem who wanted to dive. She may want to discuss her problem with someone who is familiar with both diving and physiology and see how it turns out.

Wetvet

 

[lragsac]

Valve disease is another one. When I started my OW training, I had severe mitral regurgitation, and yet the doc cleared me. She never should have. (I also had PFO but didn't know it). Luckily I survived the first 6 months or so of my diving career until I required valve replacement surgery. My PFO was repaired at that time as well. Now I'm good to go.
So, one could have valve disease that doesn't yet meet the criteria for surgical intervention, but is contraindicated for diving.

 

[saholz]

I've dived with Lauren and can personally attest to the fact that, for a woman in her late 70's, she's an amazing and active diver. Even though she needs help getting in and out of the water, her heart surgery really hasn't slowed her down at all.

ut:

Stan

 

[lragsac]

saholz once bubbled...
I've dived with Lauren and can personally attest to the fact that, for a woman in her late 70's, she's an amazing and active diver. Even though she needs help getting in and out of the water, her heart surgery really hasn't slowed her down at all.
ut:

Stan

I had my 90 year-old dive buddy Stan to help me out of the water!
Wow, talk about a virile old geezer
Yeah, dude, I'll see you in the water when I really am in my late 70's....

 

[terrydarc]

...or the potential for them. I'd think they could be seen in angiograms or otherwise diagnosed as a potential defect. That was the line I was leaning toward assuming this MD actually knew about diving with heart disease or was merely outgassing maybe to avoid liability.

Is PFO or other mentioned heart problems problematic for diving because of increased pressure or activity or both?

I hadn't thought of the circulatory problems and find that interesting especially in light of the potential for plaque buildup in a large portion of the (overweight) American public including divers.
=Terry

 

[Drew Sailbum]

Neurocardiogenic syncope and other realted disorders can cause dramatic swings in blood pressure and/or heart rate. Potential for loss of conciousness would be a concern that likely would result in a doctor refusing to clear a patient.

 

[The Iceni]

terrydarc once bubbled...
...Is PFO or other mentioned heart problems problematic for diving because of increased pressure or activity or both?
=Terry

Hi Terry,

I am no cariologist but entirely agree with Wetvet that there are any number of heart conditions that would be a relative contraintication to diving. The most worrying and common, of course, being ischemic heart disease. An MI at 20 metres would not be good! Cardiac valve disease simply puts an added strain on an already stressed heart but does not directly increase the risks of DCI.

In the case of a patent foramen ovale the diver runs an increased risk of rapid onset, severe, progressive, neurological DCI due to bubbles crossing the defect in the atrial septum, that is the wall between the right and left atria of the heart.

It is now generally accepted that detectable (and undetectable) bubbles are found in the great veins during the ascent from any dive. If the anatomy is normal these are safely mopped up by the lungs, are therefore not problematic and do not cause DCI.

When an atrial septal defect, such as a PFO, exists these bubbles can, under certain rare circumstances, find their way into the LEFT atrium and thence via the arteries to the vital organs, including the brain. Perhaps a search on the board for Patent Foramen Ovale would further enlighten you, as will this link.

Although a large atrail septal defect can cause a degree of hypoxia, the very real significance of a small PFO has nothing to do with pressure, depth or (directly) the level of exercise, it is because it can produce a right-to-left shunt.

I am having my own PFO fixed on Thursday!

Hope that helps,

 

[wandernsoul]

I hope all goes swimmingly well with your surgery Paul. I had a PFO repair done many years ago. It wasn't diagnosed till I was 21 cuz it was a 'quiet murmur'. Wellll, that's because the hole was the size of a quarter!! and the blood flowing through met no resistance. Anyway, it was successful surgery, despite the fact that my surgeon's name was COFFIN and my name is GRAVES!!

I'll be thinking of you on Thursday. Let us know how you do with your recoup.

Beck

 

[terrydarc]

in the surgery, Paul. So you've been diving with some PFO but not enough to stop you. Interesting about bubble formation and coupled with the next post from Beck about the undetectibility of PFO, it might explain some of the variability in DCI.


Beck - how did you find out about your quiet murmur being a PFO? You are quite brave and immune to superstition on the naming basis of doctors alone.

I've had and have a very quiet murmur that about 50% of doctors comment on. The others are probably hard of hearing. I'm pretty sure it's not a major problem since I'm fit aerobically and can run for miles and have been doing so for many years. Let's hope so anyway!
=Terry