Cardiovascular Disease and Diving

DAN® medical information specialists and researchers answer your dive medicine questions.

I had a stent placed earlier this year. My cardiologist is satisfied with the results and has cleared me to return to diving. The dive resort for my upcoming trip wants confirmation that the medications I'm taking are safe for diving. My doctor prescribed Brilinta (ticagrelor), Lasix (furosemide), Altace (ramipril), Zocor (simvastatin) and Toprol (metoprolol). I am 62 years old and have been diving for 34 years.
Unfortunately your question doesn't have a one-size-fits-all answer. The most important thing to understand is that doctors do not evaluate medications for safety; they evaluate the diver. The question is not "Are my medications safe?" but rather "Am


I safe to dive?" Although medications are an important consideration when determining your fitness to dive, it is often the underlying condition for which you take the medications that you and your doctor need to evaluate in detail. Medication side effects may be a concern for diving, but the underlying diagnosis should be the focus when deciding someone's fitness to dive.

Cardiovascular conditions need careful evaluation that may require input from both the cardiologist and dive medicine physician. Compressed-gas diving introduces significant changes to the diver's physiology that the body doesn't experience with land-based sports. According to the 2018 edition of DAN's Annual Diving Report, cardiac disease is the leading suspected cause of death for divers 50 years old and older while diving. A fitness decision for someone to return to regular exercise activities does not necessarily equate to whether someone is fit to dive.

The medications you listed are indicative of cardiovascular disease. While cardiovascular disease alone does not prevent you from diving, the extent of the disease may. Multiple medications may indicate multiple conditions that require control to minimize a heart attack or stroke. Any one medication is generally not an issue provided the condition is well-controlled, and your doctor needs to determine if diving would be a relatively safe activity for you. Your physician may want additional information such as exercise stress testing or even an echocardiogram to make that determination.

DAN is available to consult with doctors and discuss risk factors specific to diving so they can make an informed decision about your ability to dive safely. We want everyone to enjoy diving but not at the risk of a possible bad outcome from an otherwise preventable event.

— Lana P. Sorrell, MBA, DMT


After a week of very conservative diving in Roatan, I waited about 25 hours before flying home. A day or two later I had pain in my neck, which I have had intermittently for years, but this time it included a feeling of pins and needles, numbness, and weakness in my right arm. I didn't have any symptoms while on the plane or shortly afterward. The intensity peaked about two weeks ago and now is getting better, but the symptoms are still present about 50 percent of the time. Could a preexisting injury delay offgassing, and why wouldn't any symptoms appear earlier? Would radiculopathy in my right arm prevent me from diving to shallow depths (less than 40 feet)?
DAN medical information specialists cannot render a diagnosis via the phone, internet or email. Arriving at a diagnosis is a complex process that requires a physician using clinical judgment, the patient's medical and dive history, symptom evolution and findings on a physical exam. We can only comment based on our limited insight and index of suspicion.

Based


on your description, it seems unlikely that your right arm symptoms could be the result of any form of decompression sickness (DCS) — especially in the absence of symptoms for a day or two postflight. Recreational divers tend to offgas any excess inert gas within the first 24 hours following the final dive. A condition or injury that compromises the blood supply to tissues may theoretically impair inert gas uptake and elimination. For this reason, some researchers think that DCS may be more likely at previous surgical or injury sites, but no data support this claim.

Regarding fitness-to-dive guidelines with preexisting spinal radiculopathy, physicians trained in dive medicine generally agree that if there are no neurological, physical or functional impairments, you can consider diving. They also agree, however, that because the similarity between neurological deficits (related to the radiculopathy) and possible DCS can cause confusion when diagnosing a symptomatic diver, a detailed neurological examination is helpful. Knowledge of preexisting neurological deficits compared with a current neurological exam with previously documented results may help a diver avoid the need for an unnecessary hyperbaric chamber treatment.

Please discuss with your physician your interest in scuba diving. Your doctor can contact DAN for a physician-to-physician consultation. We can also refer you to a doctor in your area who is trained in dive medicine.

— Daniel A. Nord, EMT-P, CHT


I was recently diagnosed with benign prostate hyperplasia (BPH). Can I still use Sudafed to aid with ear equalization when diving?
BPH is a condition in which the prostate gland becomes enlarged. It is common in older men, affecting a large percentage of men over 60 years of age. Divers often use the decongestant pseudoephedrine (Sudafed) to assist with middle-ear equalization. These decongestant medications are a class of drugs known as vasopressor adrenergic.

Physicians recommend that patients with BPH and other prostate conditions avoid taking decongestants. This medication causes tightening of muscles in the prostate and neck of the bladder, making it difficult to pass urine.

Antihistamine


medications also pose potential complications for a diver with BPH. Seasickness or motion sickness plagues many divers, who often take antihistamine medications such as Bonine (meclizine) and Dramamine (dimenhydrinate). These medications can slow the flow of urine by not allowing contraction of the bladder muscle.

Using decongestants and antihistamines if you have a history of BPH could lead to urinary retention and become an emergency, possiby in areas where medical care is limited or not convenient. Consider consulting with your treating physician to find safe alternatives to these medications.

— Travis Ward, EMT-P


I need a filling and a crown. What do I need to discuss with my dentist to address the possibility of tooth squeeze (barodontalgia) from air pockets? Are there other dental issues with scuba diving about which my dentist should know?
As a diver descends in the water, the ambient pressure increases and subsequently decreases upon ascent. This pressure change is easy to equalize in air spaces that have a natural opening to the outside, such as lungs and ears. When a tooth is damaged or decayed, air may enter but have no way of being equalized. The diver may experience tooth pain (barodontalgia) during descent as the air compresses with depth and/or on the ascent as the air decompresses. Tooth pain can also occur if dental care was of poor quality and allows air to enter or if an air space remains within the tooth. Air spaces can cause severe pain and even cause fillings and crowns to become loose or dislodged.

Tell


your dentist that you are a scuba diver, so it is important to treat caries and repair defective dental work before diving to avoid air entrapment in your teeth. You should address any pain that comes with chewing, because in the course of normal diving you will be biting down on a regulator mouthpiece. Be sure to allow enough time for complete recuperation from any dental procedures before leaving on a dive trip.

Forcefully clenching your teeth on your regulator mouthpiece can damage teeth and dental restoration work. Existing fillings and crowns age or can become damaged. Silver fillings generally last 10-15 years, while composite fillings last only 5-7 years on average. Crowns may last 5-15 years. New caries can form.

Your dental health should be included in your overall plan to maintain your dive fitness. Divers naturally give priority to aspects of dive health such as avoiding decompression sickness and monitoring cardiovascular health, and indeed these are high priorities. Severe tooth pain can also quickly ruin a dive trip, especially in remote areas or on liveaboards where there is no dentist to be found.

— Sheryl Shea, RN, CHT


I'm taking multiple medications. What do I need to be aware of when taking medications while diving?
Medications treat a variety of conditions. Some medicines treat an acute ailment such as an infection, and others are for daily maintenance of a chronic condition such as high blood pressure. So not only are the medications of concern, but also important are the conditions for which your doctor has prescribed them. Medications are probably metabolized in the water the same way they are on land. There is a concern, however, for potentiation in a hyperbaric environment or one with elevated partial pressures. Of special concern are psychoactive medications. For a DAN medic to be able to assess your fitness to dive, please provide a complete list of your medications when you call.

While


medications are classified to determine their suitability to take during pregnancy or to determine the likelihood of developing an addiction, there is no classification of their safety for divers. Medications are dispensed with warnings about operating machinery or driving a vehicle while taking them, and such precautions may be as important while diving.

If you are taking a new medication, plan to wait a month before diving to understand how the medication affects you and your condition. If you experience drowsiness, delayed response or any other inability to function normally, it is best not to dive until you have finished the medication. If it is for a chronic condition, talk with your doctor about finding a suitable substitute that will allow you to be fully functional while diving in case a problem occurs. Be aware of side effects and other limitations. When taking a beta-blocker to control high blood pressure, for example, there are often exercise limitations imposed that could present an issue if you are climbing a ladder while wearing your full kit or if you are swimming against a current.

The next time you get a prescription filled or refilled, take a moment to read the insert that comes with the medication. Speak with the pharmacist about the most common side effects and then discuss these with your physician. Some side effects may mimic the signs and symptoms of decompression sickness (DCS) and could make a DCS diagnosis difficult.

— Robert Soncini, EMT-P, DMT

© Alert Diver — Q1 2020