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DAN Europe Medical Q&A
from Scuba Diver #63
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Ask DAN
DAN medical specialists and researchers answer your dive medicine questions
Orbital implant and diving Q: I’m getting older and am worried about a hardening of the arteries. Does this make diving dangerous?
A: Coronary atherosclerosis is commonly described as ‘hardening of the arteries’. It’s the result of the deposition of cholesterol and other material along the walls of the arteries of the heart. The walls of the arteries, in response to the deposition of this material, also thicken. The end result is a progressively increasing blockage to blood flow through the vessel. Many factors contribute to the development of coronary atherosclerosis: a diet high in fat and cholesterol, smoking, hypertension, increasing age and family history. Symptomatic coronary artery disease is a contraindication to safe diving - don’t dive with it.
Coronary artery disease results in a decreased delivery of blood - and therefore, oxygen - to the muscular tissue of the heart. Exercise increases the heart’s need for oxygen. Depriving myocardial tissue of oxygen can lead to abnormal heart rhythms and/or myocardial infarction, or heart attack.
The classic symptom of coronary artery disease is chest pain, especially when it follows exertion. Unfortunately, many people have no symptoms before they experience a heart attack. Cardiovascular disease is a significant cause of death among divers. Older divers and those with significant risk factors for coronary artery disease should have regular medical evaluations and appropriate studies performed (eg, treadmill stress test).
Medications typically used in the treatment of this disease include nitroglycerin, calcium channel blockers and betablockers. At some point, someone with coronary artery disease may need a revascularization procedure, or the re-establishment of blood supply, through bypass surgery or angioplasty. If the procedure is successful, the individual may be able to return to diving after a period of healing and a thorough cardiovascular evaluation.
Elbow pain Q: I made two dives about a month ago. The first was to 27m for 20 minutes, and the second was to 11m for 35 minutes. I was well within my computer guidelines, we did not do a safety stop, and I may have had one slightly fast ascent. I was OK until about four days after the dive, when I noticed a sharp pain in my elbow. If I’m not using my arm, I don’ t notice any pain at all. But if I rotate my forearm or bend my elbow, I still get a dull ache. Is there any way this could be related to my dives?
A: If you were symptom-free for four full days, then it is unlikely that subsequent symptoms are related to decompression illness and your dive. The nitrogen you absorbed during your dives has to follow the physiology of basic gas laws - it cannot stay in the body tissues once the partial pressure of nitrogen in the ambient air we breathe drops down to sea-level pressures.
Although nitrogen leaves the body in a much slower fashion than we take it on, it still must leave. After diving, you should be equilibrated to ambient nitrogen in 24 hours.
If the pain can be produced with movement of the affected joint only, then it is more than likely a musculoskeletal strain or injury. The pain generally associated with decompression illness is not affected by movement or lack of movement and usually remains fairly constant. The ability to reproduce the symptom with movement indicates a stress or repetitive movement injury. If you have not seen your personal physician it would be wise to do so. Appropriate therapy is indicated to prevent permanent injuries.
Join DAN to get a number of benefits, including answers to all your diving-related medical questions: www.daneurope.org
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