Diving with dilated cardiomyopathy

[GeorgeLennon]

Hi, I’m looking for a recommendation as to diving with cardiomyopathy.
Im 56yo make don’t smoke, drink or use drugs. I am fit, muscular and work out 4-5 days week both weights and bikes biking.
Last September I became shortbreads f breath and was eventually diagnosed with idiopathic dilated cardiomyopathy. My ejection fraction was 20% with severe functional mitral valve regurgitation. After meds including carvedolol, lisinopril and Ladin my EF came up to 30% and regurgitate went to moderate. I feel fine and my exercise tolerance is great.
Of course my question is whether I should be diving. I keep it shallow and rarely go below 60’. I only dive in warm water low stress environment.
My doctor is unsure so I would appreciate any input. I’ve been diving for more than 40 years and don’t want to stop.
Thank you for any help you can give.

 

[rsingler]

As a cardiac anesthesiologist, and avid 35-year diver, I appreciate your dilemma.

If your question is truly

whether I should be diving

the answer is easy - of course you shouldn't. But we rarely ask what we truly mean.

I will answer based only on the data you have provided (and ignoring some of it).
A person with a 30% ejection fraction and moderate mitral regurg is strolling along the edge of a steep hillside. Aware of his risk, he keeps to the well-worn flat trail at the top. But if he decides to go picking flowers that are...right over there!...just a little way down the face of the hill, then the equation changes. He'll be careful. But what about a little slip? Does he have the cardiac reserve to clamber back up to the top?

Now do this same mental exercise, not in the fresh air, but underwater. If "a little slip" is accompanied by feeling faint, will your reg stay in? Will you be able to maintain buoyancy control?

I am suggesting that it appears you can dive (I am pointedly ignoring that you "feel fine and [your] exercise tolerance is great". Your abilities may well be just fine, on the flat trail at the top of the hill. That's not where it counts. Your numbers are on the shoulder of the curve).

This is really a risk/benefit question, for you and your family. I once counseled a wife whose husband was dying from cancer, when he wanted to keep participating in the Air Force Reserve, and all she wanted was to have him home for as long as she could. His service was a huge motivation to keep living, and she compromised such that he stayed in his squadron and stayed motivated right to the end, at the price of a few more weekends away from home. She may have hated me, but he was proud to serve.

How much does diving mean to you? Have you discussed with your family maybe, just maybe, not coming back from an unexpectedly strenuous dive?

Idiopathic cardiomyopathy means we can't explain exactly what happened. I'm glad things have improved for you! Your current status is having about half of normal cardiac output, coupled with a still significant valve leak.

We really can't answer your question, if it's really "will I likely get away with doing something slightly strenuous that I love?"
Maybe you will, if things always go pretty much as planned. But will they?

Two more pieces of data you might query your doctor about, are your coronary artery status and your measured reserve. You're young, and your coronaries are likely clean. If so, your dilemma persists. But if you also have some coronary atherosclerosis, it gets easier to say, "you've had a great forty years diving. Time to find another hobby." During a treadmill test, how many Mets of exercise can you maintain? What does your cardiac contractility look like then, on transthoracic echo? How is your valve functioning then?
EDIT: If you can maintain significant exercise and your cardiac function just keeps plugging along, then I'd say someone underestimated your ejection fraction, and you may well be safe to dive. I just don't know.

I apologize for being blunt. I wish you health and luck as you ponder this difficult decision. I don't even know what I would do, in your shoes. Ask your doc a few more questions, and ponder.

Diving Doc

 

[Pao]

Short answer. Very bad idea.

 

[GeorgeLennon]

As a cardiac anesthesiologist, and avid 35-year diver, I appreciate your dilemma.

If your question is truly

the answer is easy - of course you shouldn't. But we rarely ask what we truly mean.

I will answer based only on the data you have provided (and ignoring some of it).
A person with a 30% ejection fraction and moderate mitral regurg is strolling along the edge of a steep hillside. Aware of his risk, he keeps to the well-worn flat trail at the top. But if he decides to go picking flowers that are...right over there!...just a little way down the face of the hill, then the equation changes. He'll be careful. But what about a little slip? Does he have the cardiac reserve to clamber back up to the top?

Now do this same mental exercise, not in the fresh air, but underwater. If "a little slip" is accompanied by feeling faint, will your reg stay in? Will you be able to maintain buoyancy control?

I am suggesting that it appears you can dive (I am pointedly ignoring that you "feel fine and [your] exercise tolerance is great". Your abilities may well be just fine, on the flat trail at the top of the hill. That's not where it counts. Your numbers are on the shoulder of the curve).

This is really a risk/benefit question, for you and your family. I once counseled a wife whose husband was dying from cancer, when he wanted to keep participating in the Air Force Reserve, and all she wanted was to have him home for as long as she could. His service was a huge motivation to keep living, and she compromised such that he stayed in his squadron and stayed motivated right to the end, at the price of a few more weekends away from home. She may have hated me, but he was proud to serve.

How much does diving mean to you? Have you discussed with your family maybe, just maybe, not coming back from an unexpectedly strenuous dive?

Idiopathic cardiomyopathy means we can't explain exactly what happened. I'm glad things have improved for you! Your current status is having about half of normal cardiac output, coupled with a still significant valve leak.

We really can't answer your question, if it's really "will I likely get away with doing something slightly strenuous that I love?"
Maybe you will, if things always go pretty much as planned. But will they?

Two more pieces of data you might query your doctor about, are your coronary artery status and your measured reserve. You're young, and your coronaries are likely clean. If so, your dilemma persists. But if you also have some coronary atherosclerosis, it gets easier to say, "you've had a great forty years diving. Time to find another hobby." During a treadmill test, how many Mets of exercise can you maintain? What does your cardiac contractility look like then, on transthoracic echo? How is your valve functioning then?
EDIT: If you can maintain significant exercise and your cardiac function just keeps plugging along, then I'd say someone underestimated your ejection fraction, and you may well be safe to dive. I just don't know.

I apologize for being blunt. I wish you health and luck as you ponder this difficult decision. I don't even know what I would do, in your shoes. Ask your doc a few more questions, and ponder.

Diving Doc

 

[GeorgeLennon]

Thank you. I really appreciate the time you took and I respect your answer. I’m a PA in the ER and I tend to push the limits even in my regular work outs. My coronaries are clear. I know I’m at risk even working out which I do 1.5 hours 4-5 times a week. I just don’t know if there is anything in particular about diving that would put me at a greater risk than an intense work out

 

[doctormike]

I dig out earwax for a living, so I don't have much to add here.

But I will point out how lucky you are that rsingler was around to put the time into such a thoughtful reply, providing you with the benefit of his significant diving and medical experience. There is rarely an easy answer to the question that you ask (I'm dealing with a similar possibility myself), and there are a lot of intangibles to consider that can't be measured in a cath lab.

Good luck with the struggle, and here's to those who help us make these hard choices.

 

[GJC]

I don't think your diving as you describe, would have any more effect on your heart than most other outside activities like hiking, swimming, or kayaking.

But your heart's condition makes you a greater risk than others for having a sudden arrhythmia like atrial fibrillation or ventricular tachycardia at any time. If it does happen to occur while diving, you most likely will drown. If it happens in your home, car or at work, you have a much better chance to survive.

You have to decide for yourself how much you like diving and what the impact would be to your loved ones if you did die while diving.

If it was me and I decided to continue diving, I would dive using the highest nitrox I could so I would be breathing higher O2 if something happened.

But I would probably decide to stop diving if I had your heart.

 

[Pao]

How Diving Affects Your Health and Circulatory System | The Heart & Diving - DAN Health & Diving

 

[Duke Dive Medicine]

@GeorgeLennon you need an in-person fitness to dive examination and I recommend that you not dive until you've had one. I would respectfully offer some amplification on GJC's statement on the exercise involved in diving (@GJC please feel free to correct me if I misinterpreted you). He said, "...diving as you describe.." which I interpret to mean very low-exercise, low-intensity diving in warm water, which he's equating to moderate exercise on the surface. That comparison is highly individual, and as @rsingler pointed out, you can't always anticipate the level of exercise involved in diving.

Further, any type of diving involves immersion. Immersion causes the blood to be redistributed in the body, which results in an influx of a considerable amount of blood to the torso. This increases cardiac preload (basically a function of the volume and pressure of the blood coming in to the heart) which increases the strain on your heart. If you add exercise and/or cold to this, your heart can be stressed in a way that it isn't on the surface. Where in California are you? I may be able to recommend a diving physician.

Best regards,
DDM

 

[GeorgeLennon]

Thank you all for your responses. While reading them I began to think about risk and at first I was willing to take the risk but then I thought of how events could transpire. Most likely I will die from a ventricular tachycardia which would be quite sudden. This could potentially put my wife at risk. I discussed it with her and if I vapor locked on a wall and was headining down fast she would come after me and that's a risk I could never take. So my diving days are done. end of story.
Thanks again.