Cardiovascular Health

What’s Left to Learn about Bubbles?

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EUBS 2017 has left us with more questions than answers, on the topic of post-dive bubbles.

Ballestra presented the preliminary results of an exploratory study of the effects of sonic vibrations on post-dive venous gas emboli detected by transthoracic echocardiography1. (more…)

Can drinking wine provide benefits for divers?

Historically, alcohol was used to treat bends in Greek sponge divers. In the late 1980s attempts to verify the possible beneficial effects of ethanol on prevention of DCS led to prevailing opinions that there was no proven benefit and that divers should not drink and dive. On the other hand, the assumption that wine drinking has beneficial effects on general health is still propagated. (more…)

Can a coronary calcium scan improve the prediction of heart attacks in older divers?

In the July 2015 issue of Undercurrent, an article titled “A better heart-check tool than a stress test?” discusses the possible benefits of a coronary calcium scan for older divers to reduce the risk of experiencing a heart attack while diving.1 This article is a follow-up to a May 2015 Undercurrent report about an overweight 65-year-old diver who died shortly into his dive while on a dive trip.2 That article, which considered preventive options such as a stress test, also presented views from Dr. Alfred Bove and DAN’s Dr. Petar Denoble and Dr. James Chimiak, who agreed with the American College of Physicians (ACP) guidelines that recommend a graded and individualized approach to preventive testing and diagnostics.

Another physician suggests in the July 2015 article, however, that older divers should have a coronary calcium scan, which he claims may provide information that will help them avoid a heart attack on their dive trips. Many walk-in clinics offer the test at a low price. “A coronary calcium scan can tell you years before a positive stress test that you are headed in that direction [of significant coronary disease] so that you can do some kind of intervention,” he said. While the statement has merit, it may be misleading in this context.

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PFO Closure and Susceptibility to DCS

PFO_HeartArt_Final2In a recent paper published in the Journal of the American College of Cardiology, Jakub Honek and coauthors presented their findings concerning diving with PFO (patent foramen ovale) closures.

To examine PFO closure and susceptibility to DCS, the researchers focused their study on two groups: 19 divers who had large persistent PFOs and 15 divers who had their PFO surgically closed.

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SPUMS 2014 Consensus Consideration

02A132RXIt is the last day of the official SPUMS 2014 Scientific Conference, and recommendations regarding patent foramen ovale (PFO) and diving have been discussed.  The following is proposed for consideration as the SPUMS position (final paper not yet edited):

  1. Routine screening for PFO in divers is not indicated.
  2. PFO test should be considered in case of:
  • History of decompression sickness (DCS) with cerebral, spinal, inner ear or skin manifestations
  • Any history of migraine with aura
  • History of cryptogenic stroke
  • Family history of PFO or atrial septal defect (ASD) in first-degree relatives

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PFO and Inner Ear DCS

Does the selective vulnerability of the inner ear to DCS help explain the disconnect between a prevalent risk factor and a rare disease?

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In his presentation at SPUMS 2014, Dr. Simon Mitchell has summarized the work he and Dr. David Doolette have done regarding the pathophysiology of inner ear decompression sickness (IEDCS) as well as some recent publications from other authors.

Mitchell addressed the reservations some experts have when it comes to the causal relationship of patent foramen ovale (PFO) and decompression sickness (DCS). Some experts say there is a disconnect; PFO must be present in many divers (one quarter), but DCS occurs only in few. Wilmshurst responds to this disconnect asserting that only divers with a large PFO are at risk and this is generally in line with the DCS statistics.

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PFO: Is It Time to Change the Course?

wooden pointerPresentations at SPUMS continue…

Peter Wilmshurst’s series of cases shows that 79% of all skin DCS have PFO, 10% lung disease and only remaining cases occur in divers with closed PFO due to severe dive exposure. Similar statistics were provided for inner ear DCS and neurological DCS. Other authors dispute association of PFO with spinal form of DCS  and say only cerebral DCS appears to be associated. Nevertheless, a large number of DCS cases could be avoided if the diver was aware of PFO and exercised caution.

How safe is the option of transcatheter closure?

Mark Turner, another cardiologist from the United Kingdom, provided a detailed presentation of the procedure, pitfalls and outcomes. The overall outcome: Successful with very low rate of adverse events.

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