Angina - How serious is it to scuba divers ?

[Laura0314]

My friend is in the process of training to be a dive instructor.

Then he had an angina attack. He wants to scuba dive again -
and he wants to continue on with his instructor training....
is that a realistic goal ? What advice can you offer us ?

Below is his data. His operation was on Saturday, and on Monday he was snorkeling in the ocean again. How soon before he can dive ? Some of his doctors say 2 weeks.... but the medical health insurence people consider him a high risk.

Please write with your thoughts !

CORONARY CT A

CAS is Zero
HR is 55bpm
LVEF is 57%
Left coronary artery is dominant
RCA small size, short segment.
No luminal stenosis
LM give off LAD and large LCX
LAD gives off one diagonal branch (D)
There is a smooth segmental luminal narrowing at proximal protion, about 50- 60% diameter stenosis and 1.7cm in length.
LCX gives off large OM1, small OM2 and small PD
LV myocardium; no hypodense wall or hypokinesia.
The technique is adequate.

IMPRESSION;

CAS is zero
LVEF is 57%
Left coronary artery dominant
Proximal segmental LAD narrowing, about 50-60% diameter stenosis and 1.7cm in length.
RCA, LCX and branches appear normal.

This is the procedure to fix it…….

http://www.medicinenet.com/coronary_...ty/article.htm


He is on the following medication:

x1 per day aspirin 80mg ASPILET…… for life……
x1 per day Plavix 75mg CLOPIDOGREL for minimum 1 year

 

[rakkis]

I'm not a physician. However, I work in a coronary biomechanics lab for the Biomedical Engineering department at Indiana University. Our group doesn't directly work with coronary stenosis, but I'm intimately familiar with the physiology and issues at hand. So I have a small bit of experience to speak from.

This is fairly typical of people with heart issues. This is not a particularly mild example. To be honest with you, once you start having narrowing like above, you're going to slowly deteriorate. The only way to put that off is following his doctor's advice and making an EXTREME change of eating and life style. PTCA will help with the angina and the narrowing in the short run, but the lifestyle change is needed for no recurrence. Be as supportive as you can and help your buddy. Excercise with him, eat well with him so he's encouraged to keep it up. I'm sure you can use a little bit of healthy living too (we all can ).

With earnest changes in his life and proper care, your friend can live a full life and even continue to enjoy relaxed recreational diving. Continuing to dive is certainly a realistic goal.


HOWEVER,
When teaching, you are responsible for every single person out there. You not only have to be healthy and strong enough to take care of yourself, but to help 1-2 people in complete distress/heart attack mode while maintaining control of everyone else and ensuring their safety.

The big factor with the issues you bring up is endurance. And having an angina attack is a sign that your heart wall was not getting fed enough blood through your coronaries for it to function properly. Now imagine the same happening while spending 10 minutes of non stop hard work working people out/in surf all with heavy gear. Let me assure you it's more rigorous that just going in by yourself. It's not a matter of just taking a break either. The physiological stress on the heart tissue can lead to arrhythmia (beating out of sync) and even into a full on cardiac episode.

I would personally be hesitant to teach when I know I have heart issues. Certainly not any time soon. I would let myself have at least 2-3 years of continuously good cardiovascular health with no recurrence of angina and clean angiographies/blood work. I would couple that with a concientious effort to improve my health and cardiovascular fitness under the direction of my doctor.

He doesn't necessarily need to stop teaching. Teaching classroom and pool with assistance while his health improves and stabilizes is certainly a great option. He'll gain experience while not playing too much with risk. Of course even this can cause enough stress.. so check with the doctor first.

*****
Also... most physcians are not familiar enough with the physical rigors and details of diving. His physicians needs to consult with DAN and eventually refer him out to someone more appropriate (i.e. a physician familiar with diving) once his condition has stabilized and is on the path to recovery.