Hole in heart growing up. Possibly closed now, safe for scuba?

[spork1]

Growing up I had a pin head sized hole in my heart. I'm not sure the type but I did have to take antibiotics when I went to the dentists etc. He said that it would most likely not close and that as I grew into a adult the murmur would not be audible either and should not effect me in any other way but he would not clear me for scuba due to this. He did say the risk would be low but still advised against it. Along with this I have a partial lbbb iirc and some bradycardia not requiring a pace maker.

A while back after a sleep study they sent me to a cardiologist due to the Bradycardia. On the echo they could no longer find any evidence of a hole in the heart. This was surprising because the doc before was doubtful about it closing. They sent me on my way with no pacemaker or treatment needed same as my pediatric cardiologist as a kid. I briefly mentioned scuba to him and again I think he had concerns from the history of having the murmur but he was not very helpful at all in explaining anything.

I emailed DAN with this info and they sent me contact info for a pulmonologist and said that nothing I told them was a absolute disqualifier. I've read here on this forum that a echo may not always show the hole if your relaxed etc. Its been a while but I'm guessing they will have me run all the tests again. If a 2nd echo shows no hole would that mean it has likely closed?

I'm fairly stressed about all of this. When I called the guys office they are having me go to my primary doctor just so I can get a referral. I just want to be sure beyond a reasonable doubt that I am fit to dive. So I'm posting here looking for even more opinions.

thanks!

 

[TSandM]

Somewhere around 15 to 25 percent of the population has a patent foramen ovale, or hole in the heart, that they don't know anything about and which causes them no problems. Some of those people undoubtedly are diving; most of them do not run into trouble as a result of doing so. When people HAVE had problems, especially problems which were otherwise unexplained and recurrent, investigation for a PFO is warranted.

If you still have an opening but it is no longer apparent on a standard echocardiogram, it is likely to be fairly small. It really should not affect a decision to dive, although being a rather safety paranoid person myself, I would probably be conservative about my profiles.

I'd actually be a bit more concerned about the LBBB and the bradycardia. Has it ever been symptomatic? (Lightheadedness, fainting spells . . . ) Many very athletic people run a chronic resting bradycardia but are quite capable of mounting an adequate heart rate response to exertion or stress. If you fall into that category, things should be fine, but I'd definitely get the opinion of someone who has looked at your EKG and also understands the likely physical demands of diving.

 

[Doc Harry]

Maybe you need a bubble study

 

[spork1]

thank you for the replies. I remember the doctor telling me that sometimes when I'm awake the heart rate is what a normal person's would be while sleeping. I've not had any troubles from fainting but have become light headed on occasion. As for the hole it may have been a vsd ... not sure though.

Mostly if I'm tired and try to over exert myself. Like on a monday morning when my body isn't ready to work yet. I have a very labor intensive job with lots of repetitive fast heavy lifting and even with being somewhat over weight I keep up with others or better once I'm warmed up. I have also experienced it during hot weather when I've had to much caffeine and in a hot tub that is overly warm but I set mine at home to about 100 and that seems to be fine for me.

Maybe scuba isn't for me anyway. We only have muddy water around here except for pearl lake and I'm not really sure how often I would be able to go. The concerns that I have may not be worth the limited amount of time I could spend doing scuba anyway.

thanks!

 

[plot]

I get light headed in those scenarios you described too, that's perfectly normal. If you have a labor intensive job you can keep up with, you should be able to handle the physical aspect of diving without any issues.

Don't be so l quick to give up, it's unreal being able to explore areas nobody else has and very few people can, it's something you can do the rest of your life, and it's something you can plan exotic trips around since your local diving is lacking.

 

[TSandM]

If this isn't something you want to do, then don't do it . . . but I don't think what you have said about your heart constitutes any absolute contraindication. If you have normal exercise tolerance and have never had any significant dysrhythmias, you are probably just fine to dive.

You might PM debersole here on SB -- he's a cardiologist, a diver, and particularly knowledgeable about intracardiac shunts.

 

[Duke Dive Medicine]

A ventricular septal defect is not necessarily a contraindication to diving because the pressure in the left ventricle is usually high enough to prevent right-to-left shunt. Your statements about your weight, left bundle branch block, bradycardia and your reaction to immersion in a hot tub are concerning, however. Dr. Ebersole is an authority and can speak more specifically to this, but based on the information you have provided I would be very concerned about you diving. I highly recommend that you seek clearance from a cardiologist and a diving medical practitioner prior to attempting to dive.

Best regards,
DDM

 

[TSandM]

Lightheadedness in a hot tub, or upon exiting one, doesn't disturb me much, but perhaps that's because I have it quite frequently. If your baseline BP is low and you get completely vasodilated from heat, standing up can be a challenge

However, I agree with DDM that going over the details of your actual anatomy AND your rhythm disturbance would be necessary before concluding that you are okay to dive.

 

[Duke Dive Medicine]

Lightheadedness in a hot tub, or upon exiting one, doesn't disturb me much, but perhaps that's because I have it quite frequently. If your baseline BP is low and you get completely vasodilated from heat, standing up can be a challenge

However, I agree with DDM that going over the details of your actual anatomy AND your rhythm disturbance would be necessary before concluding that you are okay to dive.

Definitely, and I wish I had a hot tub I could experiment with ;-) I thought that with this particular individual in the context of the rest of the comorbidities mentioned that it could be significant.

 

[spork1]

I think with the hot tub it has something to do with more blood flow in the lower part of your body and when you stand up it goes rushing to your head which seems to be a common experience after searching the net. Getting up slower seems to help as suggested in a hot tub forum that I read. After using it often I don't seem to have anymore troubles especially if I keep the temp around 100. I debated for a long time about purchasing a tub and I am quite happy I did. There is a lot to learn about the chemistry though to take care of it properly and you have to be more precise than with a pool.

My blood pressure has been a bit high lately but not enough for medication. I work nights and haven't been sleeping great and its probably all tied together with the weight I've put on lately. If I do take scuba classes or not the first thing on my plan was to get my sleep and weight back under control before I even started. We have a gym here I'm thinking of joining.

I guess my concern about going to all of these doctors is that our dive medicine specialist here is a pulmonologist while the questions I have are about cardiology. If I go to a regular cardiologist I suspect as before they will tell me no just to be on the safe side without having any scuba medical related training. It would be nice if my primary care could order the tests and the results could be sent over to a cardio dive specialist without me having to be there.

Scuba is something I would like to try but being able to find a experienced local doc is certainly a hurdle. Along with not being able to go very often does put me off a bit. Maybe once a year to a tropical area. I think water is scary but fascinating and the possible medical issues makes me more nervous about it. I also just came across some articles about diving being linked to brain damage even if you follow all the decompression methods and don't have symptoms.

Maybe I have ocd and my risk management is over conservative.