Sport diving is a fascinating activity allowing exploring and enjoying the underwater world and marine life. It offers a unique combination of adventure, tranquility and physical exercise. It is also a safe sport, as long as its rules are respected. These rules include being physically fit for the challenges faced, namely: Pressure increase resulting from water immersion; Cold; Sea currents, which may be strong and not favorable. When diving, cardiovascular system is the main body system put to the test. That is why around 30% of deaths related to sport diving are due to cardiovascular events. Cardiovascular health assessment before starting diving and regularly thereafter is essential. Even if the diving is sporadic. I'm healthy, do I need a medical appointment before diving? Even when there are no known illnesses, it is very important to assess whether the physical capacity is adequate to dive and exclude any possible heart problem that has not yet give rise to symptoms. Therefore, a medical appointment is always recommended. As a general rule, anyone over 45 years of age with risk factors for cardiovascular disease, such as high blood pressure, diabetes, high cholesterol, obesity and smokers, should be evaluated by a doctor before starting diving. In some cases, it may be necessary to undergo medical tests to check for coronary artery disease, among other problems, such as an electrocardiogram, echocardiogram, exercise stress test and possibly a computed tomography angiography of the coronary arteries. At any age, if a heart disease has been diagnosed, a medical assessment is needed before diving. Are there some heart diseases that may contraindicate diving? Yes! Diving is a demanding activity for the cardiovascular system. When diving blood pressure and heart rate increase, blood oxygen levels fluctuate and, for these reasons, some heart diseases disqualify a potential diver from practicing the activity. These are some examples: Untreated coronary artery disease, including angina pectoris and prior history of acute myocardial infarction; Cardiomyopathies; Heart failure; Diseases that increase the risk of arrhythmias and that can cause loss of consciousness in the underwater environment; Congenital heart diseases; Severe valve diseases. On the other hand, divers who have some symptoms, particularly those that limit physical capacity, should be evaluated in detail, namely: Inability to perform moderate efforts, for example climbing 2-3 flights of stairs; Chest pain associated with exertion, shortness of breath, palpitations or loss of consciousness; History of heart murmur; Uncontrolled hypertension; Family history of premature death (sudden/unexplained or of cardiac origin). I have heart problems and I've already gone diving without anything happening, can I continue? It depends! The answer to this question certainly an assessment in a cardiology consultation and/or by a doctor specializing in underwater medicine. The fact that you have heart problems and nothing happened while diving does not mean there is no risk or that nothing will happen. Some heart diseases are absolute contraindications for diving because they increase the risk of an acute event, such as a cardiac arrest underwater, which certainly leads to death. Additionally, some heart diseases increase the risk of air embolism and decompression sickness , which are complications of diving. For this reason it is necessary to exclude an exhaustive list of diseases before concluding whether or not you can continue. When it comes to cardiovascular risk factors, such as high blood pressure and diabetes, there is no absolute contraindication for diving, but it is essential that the doctor checks that they are controlled and excludes heart disease, usually using some diagnostic tests. Should I rule out that I have a patent foramen ovale (PFO) before diving? The patent foramen ovale is a small communication between the atria that is present in around 25% of people, most of which do not have any symptoms. However, the presence of patent foramen ovale increases the risk of air embolism. The identification of a FOP in a diver who has had a diving complication necessarily requires its treatment and closure. Knowledge of the presence of a FOP in a diver who has never had a complication requires an assessment of the risk/benefit of continuing with the sport, with a cardiologist and/or doctor specializing in underwater medicine. In other divers, active FOP search is not recommended, particularly if there are no risk factors; however, performing an echocardiogram may clarify this doubt. Remember Diving is a fascinating but demanding activity that requires careful assessment of the cardiovascular system. Assessment by doctors specialized in underwater medicine and by a cardiologist when there is cardiovascular disease is essential to guarantee safety when diving. Author: José Ferreira Santos Source Diving medical guidance to the physician . Undersea and Hyperbaric Medical Society. Meet the Cardiology clinical team of the Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
