Accelerated heartbeat/breathing episode underwater w/tingling above water:Dehydratio?

[DocVikingo]

The hospital did not do any blood work. They did check my pulse by putting some sort of thing over my finger, not sure if that is how an EKG is done these days.

Hi Ryan,

No, that would not have been an EKG, which involves surface electrodes being placed about the chest and torso. I suspect that device was a finger heart rate monitor.

Does anyone recommend some testing I should have performed?

The diving medicine specialist will know what diagnostics to perform. At a minimum, these likely will include a physical examination, an EKG, blood work up including a CBC (Complete Blood Count: The Test) and at least an SMA-6 (Blood Chemistries), and a fasting plasma glucose test (Tests to Diagnose Diabetes: Fasting Plasma Glucose Test and More).

Please let us know how matters progress. It’s how we learn.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[TSandM]

I would definitely get an electrocardiogram. Although it may show nothing, there are certain types of arrhythmias that have some markers on the EKG, even when the arrhythmia is not present.

 

[ScubaNurse758]

Has anyone thought of a possible exhaustion component to the differential?? I know sometimes after 4 or 5 12-14 hour shifts in a row I can start to have some of those symptoms. I would, however, suggest a good workup as some of those symptoms (tachycardia, possible "fluttering" in the chest) could definitely be signs of a more serious condition.

Jordan.

 

[Bubbletrubble]

This incident could be a blessing in disguise.
It's certainly possible that a cardiac arrhythmia or some other medical condition could reveal itself in this way.
Please keep us posted on the results of your check-up.

 

[Rick Murchison]

My questions about Singha and decongestants were not entirely in jest.
A few days of party-hearty combined with diving can lead to serious dehydration; in many folks decongestants can set the heart off-to-the-races. I, for example, can drive an EKG crazy with irregular/rapid/pvc heartbeat for two or three days just by taking a single sudafed. Feels like my heart's about to jump out of my chest.
Rick

 

[ScubaNurse758]

Ryan, Just wondering if you had gotten a workup from a doctor or had anymore symptoms lately?

Jordan.

 

[cutlass]

I'm reading descriptions which are somewhat incomplete or atypical of first-thought conditions; dehydration, cardiac event, acidosis (retained CO₂). Heart rate and systolic pressure (high) both elevated but no report of advanced dehydration or shock; unlikely but poisoning or envenomation still an open question. No headache, nausea, chest tightness. Tingling but not frank pain in suspicious patterns.

Of course given the acute onset and general symptoms, a first-look ECG is certainly warranted. On the bloodwork, I'd be sure to note BUN and creatinine levels.

 

[RyanDelMundo]

Hey everyone,

Finally made it to the hospital yesterday. In summary, they seemed to think it was a one-off weird event with no real solution.

I arrived, mentioned my symptoms and said I'd like an EKG. Had that done and spoke with the doctor.

Apparently the EKG looked absolutely fine. Apparently if it is random they put me on the EKG for 24-hrs to watch for it, but she didn't think anything of it.

It wasn't the same doctor as last time but seemed to have a decent knowledge of dive medicine (asked depths and times, etc). She then gave a call to another doctor who she said had been trained by DAN. As they talked in Thai I couldn't understand the conversation, but this other doctor didn't think too much of it. He recommended that perhaps I only dive twice a day and not three!

I said that I didn't think this was DCS and was still looking for a better answer.

So she recommended I talk to a cardiologist. So that was a 2 wait, then spoke with her for a bit. At this point I pulled up this email thread and she read them and said, ok, we can do some blood work.

So had that done, another wait for analysis of course, and back to see the cardiologist.

All the blood work checked out in the normal range. Had the following done: Electrolytes, BUN(13), Creatine(1.0), and RBS (121 a shade high, but I had just eaten dinner...). She also thought to check my thyroid which turned out to me normal. CBC was done as well with all checks normal.

In the end she also wasn't much worried about it and said it was probably random.

Gave me 10 tabs of propranolol in case this happens again, which apparently might also help my golf game, not that I golf.

If anyone is curious about medical care here at a nice private hospital, the consultation and EKG cost me about $45. But damn, the blood work came in at $120! I imagine that's cheap compared to back home, haha.

So in the end, no real smoking gun, just a bit of peace of mind that nothing is seriously wrong.

Thanks again for all the advice. I'm happy to answer detailed followup questions about test results, etc.

And yes, these days, I feel like a million bucks. And this afternoon, I'm off to ride a motorbike, which is way riskier than diving.....funny how we rationalize risk...

Cheers,

Ryan

 

[Bubbletrubble]

I'm glad you followed up with some testing.

If I were you, I'd be wary of taking propranolol (beta-blocker) while diving. The effects of the beta-blocker will reduce one's exercise tolerance which can, in some cases, cause a person to lose consciousness (related to decreased blood pressure and decreased heart rate). That would be a very unfortunate thing to have happen while diving. And we all know that diving can be a work-out at times.

Did the physician who gave you the prescription caution you about this?

 

[RyanDelMundo]

My questions about Singha and decongestants were not entirely in jest.
A few days of party-hearty combined with diving can lead to serious dehydration; in many folks decongestants can set the heart off-to-the-races. I, for example, can drive an EKG crazy with irregular/rapid/pvc heartbeat for two or three days just by taking a single sudafed. Feels like my heart's about to jump out of my chest.
Rick

Hey Rick,

Yes of course there are always some beers involved and everyone in my dive shop has been saying how easy it is to become dehydrated with the diving and the heat and the like. I also think Nitrox air is more dry than regular air and might make dehydration more of an issue.

I am nearly positive on the day in question I hadn't taken any decongestants but perhaps a week before I developed a head cold and had been taking Declogen, two tabs twice daily (Decolgen tab Paracetamol 500 mg, chlorpheniramine maleate 2 mg) for maybe three days. I also had dengue back in December and took quite a few of those Declogens to get thru (thankfully a very mild Dengue, tho I got the itches quite bad).

Perhaps something to do with those pills?

As a hydration aside, a lot of the folks think the distilled drinking water should never be drank as it lacks minerals and such. They say always drink mineral water. I have never drank mineral water and think that's a bunch of hogwash, so long as you eat well.

Anyway, I have a new appreciation for the complexity of human systems.

- Ryan

(Rick, I like your quote by the way. The one I like to say is "you can have time or money, but never at the same time.")