Diving after Heart Attack

[Footslogger]

Yeah ...things like this just don't happen to guys like me.

But like it or not, a little over 3 weeks ago I had a serious attack. No prior symptoms or history. Exercise regularly, not overweight, don't smoke and maintain a good diet.

Long story short, I made it to the hospital, was whisked off to the cath lab where they found a complete blockage of a major coronary branch. Blockage was removed and stents placed. Afterwards it was determined that my left ventricular function was pretty low so they suggested an implanted defibrillator.

So ...I went from a picture of health to a cardiac rehab patient in 24 hours.

We had a dive trip scheduled for May, which we went ahead and cancelled. But my big question is ...will I ever be able to dive safely again. Amazingly the cardiologists don't have a clear answer to that question.

Anyone else out there who has suffered a heart attack, has an ICD and still dives ??

Thanks in advance

[DivingPrincessE]

Sorry to hear about that experience, but I'm glad to hear you're ok. Some people will surely chime in but have you tried calling DAN? I think they would really be able to weigh in on this with some great and accurate info.

[Footslogger]

I definitely intend to check with DAN as well as getting additional opinions from cardiologists ...I just wanted to know if anyone here on SB is diving with an ICD.

Thanks in advance ...

[Thadmn]

I used to work for Guidant and now work for St. Jude Medical, both manufacturers of pacemakers and ICDs. The cases or "cans" of these devices are made of titanium to reduce weight and are totally sealed. After being welded together, they are helium leak tested. It is OK to swim with them, however the "can" is quite thin and I would think that the pressure while diving would cause the sides to bow inwards and could possibly cause damage to the batterries, capacitors, and other components. If you know which company made it, most likely Medtronic, Guidant (now Boston Sciantific), or St Jude Medical, you could call and ask. I'm pretty sure that the answer will be,"we don't reccomend it".

I have thought about this very question myself and have thought that if they totally encapsulated the insides with epoxy, it would be possible. There are reasons that they don't do this because you can't expose the batteries and capacitors to the temperatures required to cure the epoxy.

I'm sorry to say this, but I don't think diving with it would be a wise move. Snorkeling would probably be alright though.

[Footslogger]

I used to work for Guidant and now work for St. Jude Medical, both manufacturers of pacemakers and ICDs. The cases or "cans" of these devices are made of titanium to reduce weight and are totally sealed. After being welded together, they are helium leak tested. It is OK to swim with them, however the "can" is quite thin and I would think that the pressure while diving would cause the sides to bow inwards and could possibly cause damage to the batterries, capacitors, and other components. If you know which company made it, most likely Medtronic, Guidant (now Boston Sciantific), or St Jude Medical, you could call and ask. I'm pretty sure that the answer will be,"we don't reccomend it".

I have thought about this very question myself and have thought that if they totally encapsulated the insides with epoxy, it would be possible. There are reasons that they don't do this because you can't expose the batteries and capacitors to the temperatures required to cure the epoxy.

I'm sorry to say this, but I don't think diving with it would be a wise move. Snorkeling would probably be alright though.

===================================

Thanks for that. The model I have is a St Judes. The initial answer I got from the St Judes rep was that the pressure would NOT be a problem. The bigger concern would be the device firing during a dive. This is definitely NOT something that has been subject to a controlled study so I'm fairly certain that most feedback will be "opinion" and not proven fact.

I'm still curious to know if there is anyone out there who has actually dove with an ICD.

Thanks again for your feedback though. Truly appreciate it.

[Footslogger]

So ...anybody diving with an ICD ??

Inquiring minds like mine want to know ...

[Al Mialkovsky]

I don't know of anyone with an ICD but I know of a couple of divers who've had serious heart attacks and still dive. One diver I know is over 70 and limits his diving to one shallow boat dive per day. That's his thing, he won't go very deep.

St. Judes claims their ICD is good to 66 feet. You have a lot of research ahead of you but it appears that diving with one isn't an absolute contraindication.

[debersole]

I'm a cardiologist with an interest in diving medicine and I lecture on such issues as fitness to dive and diving with cardiovascular disease. I'm also a CCR trimix diver/instructor. Here is my 2 cents.

Yes, selected people can dive after suffering a heart attack. The key word in that statement is "selected". The current recommendation for being able to return to diving after sufferiing a heart attack is for the patient to have normal left ventricular function (i.e. a strong heart) and have good exercise tolerance (13 METs --> 12 minutes on a standard Bruce treadmill) and no evidence of ischemia (no residual blockages).

As far as defibrillators (ICDs) go, it is not the ICD itself but the indication for the ICD that usually disqualifies someone from diving. Most people who require ICDs after a heart attack have very weak heart muscle function which would disqualify them from diving. If the patient has normal heart muscle function but requires an ICD it would likely be because of lots of dangerous heart rhythms such as ventricular tachycardia which also would be a disqualification for diving. In the rare event that neither of these apply, the current generation ICDs can usually be safely pressurized to at least 3 ATA so that they can be used in a hyperbaric chamber for wound care patients, etc. Most of the data is with pacemakers and not ICDs where the generator "can" may deform slightly under extreme pressure but the device works properly. St. Jude even has a pacemaker (not an ICD) that is rated to over 200 fsw! Your device company can give you some assistance in this matter.

The last issue is your stent. The healing process for stents is about six months. This means that if the stent stays open for six months it will probably stay open indefinitely. A frequent recommendation is not to dive for six months after your heart attack to see how the stented area is going to heal. If too much scar tissue builds up (kind of an "overactive" healing process) you may need another angioplasty procedure.

I hope this helps. If you have any questions or would like me to discuss your specific case details, feel free to PM me.

Doug

[TSandM]

Deleted because debersole posted while I was writing . . .

[Footslogger]

I'm a cardiologist with an interest in diving medicine and I lecture on such issues as fitness to dive and diving with cardiovascular disease. I'm also a CCR trimix diver/instructor. Here is my 2 cents.

Yes, selected people can dive after suffering a heart attack. The key word in that statement is "selected". The current recommendation for being able to return to diving after sufferiing a heart attack is for the patient to have normal left ventricular function (i.e. a strong heart) and have good exercise tolerance (13 METs --> 12 minutes on a standard Bruce treadmill) and no evidence of ischemia (no residual blockages).

As far as defibrillators (ICDs) go, it is not the ICD itself but the indication for the ICD that usually disqualifies someone from diving. Most people who require ICDs after a heart attack have very weak heart muscle function which would disqualify them from diving. If the patient has normal heart muscle function but requires an ICD it would likely be because of lots of dangerous heart rhythms such as ventricular tachycardia which also would be a disqualification for diving. In the rare event that neither of these apply, the current generation ICDs can usually be safely pressurized to at least 3 ATA so that they can be used in a hyperbaric chamber for wound care patients, etc. Most of the data is with pacemakers and not ICDs where the generator "can" may deform slightly under extreme pressure but the device works properly. St. Jude even has a pacemaker (not an ICD) that is rated to over 200 fsw! Your device company can give you some assistance in this matter.

The last issue is your stent. The healing process for stents is about six months. This means that if the stent stays open for six months it will probably stay open indefinitely. A frequent recommendation is not to dive for six months after your heart attack to see how the stented area is going to heal. If too much scar tissue builds up (kind of an "overactive" healing process) you may need another angioplasty procedure.

I hope this helps. If you have any questions or would like me to discuss your specific case details, feel free to PM me.

Doug

======================================

Thanks Doug ...that is the type of information I was hoping to get.

I'm in no hurry to return to diving. I just want to know if I should be getting my diving and u/w photo gear inventoried and ready for sale.

My ICD was placed due to low left ventricular function. Ejection fraction one week following the MI was around 35%. The cardiologists felt that I was in a relatively high risk category for sudden dysrythmia. That said ...I was in otherwise excellent health prior to the attack and they do anticipate (as do I) that my left ventricular function will improve.

I also appreciate what you said about the stents and it is consistent with the advice from my cardiologist.

I start rehab next week so we'll see how my exercise tolerance improves.

This is all pretty mind boggling for someone who went from an apparent picture of health to a cardiac patient overnight. I am not overweight, don't smoke, get plenty of exercise and eat healthy foods. My cholesterol numbers were a little high but not enough to set off alarms and they had improved significantly over the past year with intake of suppliments (Omega3, Flax Seed Oil and Grape Seed extract). Pretty sure I was a victim of genetics.

Anyway ...I really appreciate your reply and might tap your brain again as time goes by. After diving now since the early 70's it is hard for me to get my arns around just going cold turkey and giving it up. But ...if that ends up being the right prescription I am realistic enough to accept it. The 2 things my wife and I enjoy the most are SCUBA and long distance backpacking. I fully intend to return to backpacking so the way I look at it ...one out of two ain't bad.

Thanks again ...