Chest pain which disappears on ascent

[scubagat]

I'm wondering if someone out there has experienced something similar to this.

I'm 42, BMI 24, reasonably fit and in good health, albeit with mild asthma for which I very occasionally use a salbutamol inhaler. I'm just shy of 200 dives.

Myself and husband have just come back from a diving holiday in the Maldives. On this particular hol we did 20 dives. On two of the dives, I developed chest pains at around 98ft depth. The second dive was particularly bad. Sharp pain in the centre of chest, heart felt like it was pounding and it hurt to take a deep breath. I wasn't short of breath and nor was I struggling to take a normal breath. There was no panic, I just suggested we start to ascend slowly. I noticed the chest pain had all but gone away after a couple of minutes and by the time we'd finished our safety stop and ascended to 2 metres (6ft) everything was completely fine and I found I could take lovely huge deep breaths again. After both dives I felt fine, no pain, no breathing troubles. On subsequent dives we went equally as deep and one occasion deeper - no symptoms whatsoever.

The dive profile for the second dive consisted of descending to 98ft in 6 minutes and smoothly ascending (including safety stop) 42 minutes. I used 1450 psi (100 BAR) Nitrox 32 which is normal air consumption for me. The water temp was 84F (29C) and there was very little current - no exertion required. My kit is well used and not constrictive. I'm pretty relaxed and comfortable in the water and not prone to panic.

I mentioned it to a couple of non-medical diving people and they said chest pain can often be caused by indigestion but I'm unsure about this since I had no acid reflux. I do suffer from indigestion quite badly in phases but last time that happened was a few years ago. Both incidents were morning dives and I cut out all fruit based drinks/food for breakfast so this may well have been the root of the problem.

I have an appointment to see my doctor this week. I'd like peace of mind to be honest. My own opinion is that it's something muscular but I'd appreciate your views/experiences of anything similar.

 

[cutlass]

Your situation is a somewhat mixed bag which really needs to be sorted out by an examination. Having said that, my quick list of possibilities include angina, reflux, pleurisy, muscular ache, sternal inflammation (costochondritis), and tracheobronchial pain from asthma scarring or spasm. Angina is the #1 concern. Reflux is the #1 suspect.

Reflux can be dependent on body position. The common diving profile of head-down descent, level off, head-up ascent could account for the symptom sequence; acid leakage during the descent and level off, relief coming from the restorative flow encouraged by an upright position. I don't see a way to correlate the remaining possibilities to the reported sequence of events*. But what's still confounding to me is your past experience with reflux and, it seems, the feeling that these episodes were different.

*The stomach commonly contains a gas bubble whose size will obviously change with depth and from air swallowed during the dive. But if there was bubble enlargement, I'd expect a sense of fullness and burping rather than sharp pain. Moreover, this would be on ascent which is the opposite of the relief that was reported.

 

[Doc Intrepid]

Strongly recommend you call DAN.

Can't hurt, and they may very well have some ideas or other data that could narrow down your possibilities or suggest yet other maladies to consider.

DAN Divers Alert Network

If you want to, let us know how your appointment goes.

Doc

 

[TSandM]

Chest pain is something I refuse to make any attempt to diagnose over the internet. Possibilities, as cutlass has already said, include anything from reflux to cardiac ischemia. Things that would be worrisome for the latter would be if the chest pain occurred during exertion (for example, as you are swimming during the bottom time portion of the dive) and was relieved by rest (for example, just floating upwards on ascent). At your age, coronary artery disease is a definite possibility and can occur in people with no real risk factors.

You can talk to DAN, but if it were me, I'd get a cardiac evaluation sooner rather than later. It may not be the problem, but that's commonest and most high-risk condition that could cause intermittent chest pain.

 

[cutlass]

Without necessarily having relevance to the OP, as a general fyi health note on exertion and angina: Although rare, angina can occur without exertion and may even elude usual treadmill testing; viz., Prinzmetal's angina. Suspicions for this possibility rise in cases of risk factors and angina-like chest pain while at rest; much more so when the event occurs during early morning hours.

 

[scubagat]

Apologies for the delay in replying - I've been logged in and reading (avidly!) but only just came back to look for a reply. Many MANY thanks to all of you, it's greatly appreciated.

I have an appointment on Friday with my doctor and I'll keep you posted with the results.