left ventricular hypertrophy and diving

[Variegated]

Hi all,

I'm a 27 year old Divecon - I recently had a dive medical and my ECG came back abnormal. The Dive doctor - (from the hyperbaric medicine unit at Adelaide Hosptial so all he does is work with divers - they have 2 chambers on site there which is why I went there) didn't mention it and signed me off as being fit to dive. However the cardio nurse who did my ECG advised me to get the abnormalities checked out.

So I took my ECG to my GP and he said it indicated left ventricular hypertrophy (LVH) and referred me to a cardiologist. He told me to stop diving in the meantime. I'm seeing the cardio next week.

From my internet research, I found that LVH can be caused by several things - most notably high blood pressure and excessive anerobic exersize.

I'm pretty fit - I cycle 18km to and from work every day and my BMI is just in the normal range, any lighter and I'd be underweight for my height -I'm not a body builder, and my blood pressure is normal. HOWEVER (big however) I spoke to my Dad about it and he said he was diagnosed with LVH by ECG in his late 20s. It didn't show up on an Echocardiogram until he was in his late 50's. So it looks like I'm genetically predisposed to this condition.

Searching around here I've found advice that people with LVH should be precluded from diving. So I guess my question is twofold - a) does anyone here dive with LVH? b)Is it a severe relative risk to diving that will end my diving career that the dive doctor just overlooked?

 

[Chocoholic]

Have you checked with Divers Alert Network Dan.com They have a lot of info RE: medical issues and may answer an email or phone question for you too.

 

[TSandM]

Meeting electrocardiographic criteria for LVH doesn't irrefutably prove that you have it. You should have an echocardiogram to look at wall thickness, ventricular contractility, and valve function before a definitive diagnosis is made.

I do not believe LVH alone would be an absolute contraindication to diving. Many people with high blood pressure have some degree of LVH, but if their BP gets treated adequately, they are OK to dive. You might fire off a PM to debersole, who is a very savvy diving cardiologist here and generally pretty good about answering questions. But I think he would agree that an echo is indicated.

 

[cutlass]

Yes, an echo will better define any heart abnormalities and help assess risks.

AFAIK, for a small percentage of athletes -- and your daily cycling regime probably qualifies -- LVH may be an adaptation rather than pathological. This would make sense of your otherwise normal BP. But even if it is an adapatation, there may still be longterm risks.

 

[Variegated]

Saw the cardio today and had another ECG witht he same result - booked in for an echo and a stress test later in the week.

Unfortunately I asked if it was a contraindication to diving and she replied "I wasn't going to say anything - but now that you've asked, I'm obliged to say it is until we've done the tests."

Damn.

 

[lulubelle]

Saw the cardio today and had another ECG witht he same result - booked in for an echo and a stress test later in the week.

Unfortunately I asked if it was a contraindication to diving and she replied "I wasn't going to say anything - but now that you've asked, I'm obliged to say it is until we've done the tests."

Damn.

Don't "put the cart before the horse" Variegated. This could be much ado about nothing, but for the moment, the smart money is on being conservative until you have had your tests done.

As our learned forums members have stated, it could simply be a normal adaptation.

Also keep in mind that there are varying degrees of LVH. My guess is that yours is on the right end of the spectrum.

 

[Variegated]

So, echo and Treadmill stress testing done:

The echo indicated no abnormalities to valve function and a septal width of 8mm - which is supposedly well within the normal range.

The stress test was a 15 minute treadmill test with intensity increasing every 3 minutes

Resting: 55bpm, bp 110/70

Max: 149bpm, bp 170/76
After 4 minutes it had dropped to 108/70

Apparently that's significantly better than normal for my age group.

The Cardio has booked me in for an MRI in 2 weeks and hasn't given me the all clear to dive unitl that's done.

Grr. Supposed to be DCing a course this weekend...

 

[lulubelle]

So, echo and Treadmill stress testing done:

The echo indicated no abnormalities to valve function and a septal width of 8mm - which is supposedly well within the normal range.

The stress test was a 15 minute treadmill test with intensity increasing every 3 minutes

Resting: 55bpm, bp 110/70

Max: 149bpm, bp 170/76
After 4 minutes it had dropped to 108/70

Apparently that's significantly better than normal for my age group.

The Cardio has booked me in for an MRI in 2 weeks and hasn't given me the all clear to dive unitl that's done.

Grr. Supposed to be DCing a course this weekend...

You will get to take the course soon. You should be jumping for joy, so far you have gotten a lot of good news! I'm in healthcare, so I always find such things as cause for celebration!

Thanks for updating us@!

 

[Dr. Doug Ebersole]

I'm a cardiologist. LVH by itself is NOT a contraindication to diving. However, there are certain conditions that result in LVH that are more problematic. I agree completely with your cardiologist in making sure this is not something dangerous. Your stress test sounds normal -- 15 minutes is an excellent exercise tolerance and apparently there were no EKG changes or rhythm disturbances. If the rest of your workup is negative, there should be no problem with returning to diving. If you have anything that I could help you with, PM me.

Doug

 

[Variegated]

So I got my MRI results back and my heart function is normal, with no protein build up in the ventricle. All clear to dive, my ECG is just a bit strange naturally apparently.

Went to the shop today expecting to assist in an open water pool session, but 2 of the OW students cancelled and they were short a divecon on a double wreck dive (love days like that). Good to get back in the water.