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Nagraj S, Palaiodimos L. Patent Foramen Ovale and Decompression Illness: The Present and Future. Cardiol Clin 2024; 42:525-536. [PMID: 39322343 DOI: 10.1016/j.ccl.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Presence of patent foramen ovale (PFO), particularly if high-grade, increases the risk of decompression illness (DCI) and its severe forms. In unprovoked or recurrent DCI, neurologic, cutaneous, or cardiopulmonary DCI, testing for PFO is indicated with bubble contrast echocardiography or transcranial Doppler using provocative maneuvers. In patients with PFO and history of DCI, evaluation by a cardiologist with expertise in diving medicine is recommended. Consideration should be given to PFO closure if cessation of diving or conservative diving cannot be achieved. Prospective studies evaluating long-term outcomes in patients who continue to dive after PFO closure are required.
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Affiliation(s)
- Sanjana Nagraj
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Leonidas Palaiodimos
- Department of Medicine, New York City Health + Hospitals/Jacobi, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY 10461, USA.
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2
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Druelle A, Mouhat B, Zbitou O, Castagna O. Static Immersion and Negative Static Lung Load-Induced Right Ventricle Systolic Function Adaptation: A Risk Factor for Immersion Pulmonary Edema. Chest 2024; 166:532-543. [PMID: 38759727 DOI: 10.1016/j.chest.2024.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/22/2024] [Accepted: 03/31/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Immersion pulmonary edema (IPE) is a form of hemodynamic edema likely involving individual susceptibility. RESEARCH QUESTION Can assessing right ventricle (RV) systolic adaptation during immersion be a marker for IPE susceptibility? STUDY DESIGN AND METHODS Twenty-eight divers participated: 15 study participants with a history of IPE (IPE group; mean ± SD age, 40.2 ± 8.2 years; two women) and 13 control participants (no IPE group; mean ± SD age, 43.1 ± 8.5 years; two women) underwent three transthoracic echocardiography studies under three different conditions: dry (participants were in the supine position on an examination table without immersion), surface immersion (participants were floating prone on the water's surface and breathing through a snorkel), and immersion and negative static lung load (divers were submerged 20 cm below the water's surface in the prone position using a specific snorkel connected to the surface for breathing). Echocardiographic measurements included tricuspid annular plane systolic excursion (TAPSE), tissue S' wave, and right ventricle global strain (RVGLS). RESULTS For all divers, immersion increased RV preload. In the no IPE group, the increase in RV preload induced by immersion was accompanied by an improvement in the contractility of the RV, as evidenced by increases in TAPSE (17.08 ± 1.15 mm vs 20.89 ± 1.32 mm), S' wave (14.58 ± 2.91 cm/s vs. 16.26 ± 2.77 cm/s), and RVGLS (25.37 ± 2.79 % vs. 27.09 ± 2.89 %). Negative SLL amplified these RV adaptations. In contrast, among divers with IPE, the increase in RV preload did not coincide with an improvement in RV contractility, indicating altered adaptive responses. In the IPE group, the TAPSE values changed from 17.19 ± 1.28 mm to 21.69 ± 1.67 mm and then to 23.55 ± 0.78 mm, respectively, in the dry, surface immersion, and immersion and negative SLL conditions. The S' wave values changed from 13.42 ± 2.94 cm/s to 13.26 ± 2.96 cm/s and then to 12.49 ± 0.77 cm/s, respectively, and the RVGLS values changed from -24.09% ± 2.91% to -23.99% ± 3.38% and then to -21.96% ± 0.55%, respectively. INTERPRETATION Changes in RV systolic function induced by immersion (especially with the addition of negative static lung load) vary among divers based on the history of IPE. Analyzing ventricular contractility during immersion, particularly RVGLS, could help to identify individual susceptibility in divers. These findings provide insights for the development of preventive strategies. TRIAL REGISTRY Comité de Protection des Personnes; No.: 21.05.05.35821; Recherche Impliquant la Personne Humaine de type 1 (RIPH1) HPS; No.: 2021-A01225-36.
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Affiliation(s)
- Arnaud Druelle
- Diving Medicine Consultation Services and Hyperbaric Chamber, Ste Anne Military Hospital (HIA Ste Anne), Toulon, France
| | - Basile Mouhat
- Department of Cardiology, University Hospital, Besançon, France
| | - Oumaima Zbitou
- Department of Cardiology, University Hospital, Besançon, France
| | - Olivier Castagna
- Diving Medicine Consultation Services and Hyperbaric Chamber, Ste Anne Military Hospital (HIA Ste Anne), Toulon, France; Underwater Research Team-ERRSO, Military Biomedical Research Institute (IRBA), Toulon, France; LAMHESS (UPR 6312), Université de Nice, Nice, France.
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3
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Algaly G, Ahmed SMI, Abdelrahman A, Elgassim MA, Parveen A. Acute massive posterior stroke with tonsillar herniation in a scuba diver. Oxf Med Case Reports 2024; 2024:omae094. [PMID: 39193478 PMCID: PMC11348004 DOI: 10.1093/omcr/omae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/18/2024] [Accepted: 06/18/2024] [Indexed: 08/29/2024] Open
Abstract
A transient female passenger in her 40s presented to the emergency department (ED) exhibiting drowsiness post-scuba diving. Despite normal initial vitals, she reported dizziness, sleepiness, and occipital headache. A computed tomography (CT) scan showed a severe posterior circulation acute infarction affecting various brain regions, resulting in significant mass effects and complications like 4th ventricle compression, cerebellar tonsillar herniation, and hydrocephalus. Extensive diagnostic tests, blood workup, and stroke evaluations revealed normal findings, except for an incidental patent foramen ovale (PFO). Collaboration with neurosurgery led to her transfer for life-saving extraventricular drain (EVD) insertion and posterior fossa decompression. Treatment included right-side EVD insertion, suboccipital craniectomy, and foramen magnum decompression. Postoperatively, she was extubated the next day, alert, without focal neurological deficits. Upon EVD removal, a repeat CT head scan showed regression of mass effect. She was discharged home safely after 16 days, fully ambulating.
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Affiliation(s)
- Gufran Algaly
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Sara M I Ahmed
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Amro Abdelrahman
- Medical Education Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Ayesha Parveen
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
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Tuominen LJ, Tuohinen S, Lundell RV, Räisänen-Sokolowski AK, Wuorimaa T. The effect of a single closed-circuit rebreather decompression dive in extremely cold water to cardiac function. Eur J Appl Physiol 2024; 124:1693-1702. [PMID: 38189825 PMCID: PMC11130038 DOI: 10.1007/s00421-023-05392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Dive-induced cardiac and hemodynamic changes are caused by various mechanisms, and they are aggravated by cold water. Therefore, aging divers with pre-existing cardiovascular conditions may be at risk of acute myocardial infarction, heart failure, or arrhythmias while diving. The aim of this study was to assess the effect of a single decompression CCR dive in arctic cold water on cardiac function in Finnish technical divers. METHODS Thirty-nine divers performed one identical 45 mfw CCR dive in 2-4 °C water. Hydration and cardiac functions were assessed before and after the dive. Detection of venous gas embolization was performed within 120 min after the dive. RESULTS The divers were affected by both cold-water-induced hemodynamic changes and immersion-related fluid loss. Both systolic and diastolic functions were impaired after the dive although the changes in cardiac functions were subtle. Venous inert gas bubbles were detected in all divers except for one. Venous gas embolism did not affect systolic or diastolic function. CONCLUSION A single trimix CCR dive in arctic cold water seemed to debilitate both systolic and diastolic function. Although the changes were subtle, they appeared parallel over several parameters. This indicates a real post-dive deterioration in cardiac function instead of only volume-dependent changes. These changes are without a clinical significance in healthy divers. However, in a population with pre-existing or underlying heart problems, such changes may provoke symptomatic problems during or after the dive.
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Affiliation(s)
- Laura J Tuominen
- Department of Emergency, Emergency Medical Services, Centre for Prehospital Emergency Care, Tampere, Finland.
- Department of Pathology, Helsinki University, Helsinki, Finland.
- Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland.
| | - Suvi Tuohinen
- Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Richard V Lundell
- Department of Pathology, Helsinki University, Helsinki, Finland
- Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - Anne K Räisänen-Sokolowski
- Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
- DAN Europe Foundation, Finnish Division, Roseto, Italy
- Department of Pathology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Tomi Wuorimaa
- Diving Medical Centre, Centre for Military Medicine, Upinniemi, Finland
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Di Paolo M, Mezzetti E, Leoni M, Scatena A, Passino C. Sudden cardiac death during scuba diving: a case report of a patient with unknown hypertrophic cardiomyopathy. Eur Heart J Case Rep 2024; 8:ytae217. [PMID: 38745730 PMCID: PMC11091920 DOI: 10.1093/ehjcr/ytae217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Abstract
Background Scuba diving is a recreational activity usually considered at low impact on cardiovascular system. However, when diving, increased ambient pressure exerts several effects on the cardiovascular and pulmonary systems, mainly due to redistribution of peripheral blood into the central circulation. This phenomenon, also known as blood shift, may produce a significant overload on a non-healthy heart. Case summary We present the case of a female patient who experienced sudden cardiac death during scuba diving: post-mortem cardiac magnetic resonance and autopsy revealed that the patient was affected by previously unknown hypertrophic cardiomyopathy. Discussion Diving exposes the body to significant physiological changes that may overstress a diseased heart. This case suggests the need for some cardiovascular exams, such as an echocardiogram or, at least, an electrocardiogram, for screening cardiovascular abnormalities in subjects who wish to practice scuba diving.
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Affiliation(s)
- Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Via Roma 55, 56100 Pisa, Italy
| | - Eleonora Mezzetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Via Roma 55, 56100 Pisa, Italy
| | - Matteo Leoni
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Via Roma 55, 56100 Pisa, Italy
| | - Andrea Scatena
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Via Roma 55, 56100 Pisa, Italy
| | - Claudio Passino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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6
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Dalecki M, Steinberg F, Beurskens R. Rapid Dual-Task Decrements After a Brief Period of Manual Tracking in Simulated Weightlessness by Water Submersion. HUMAN FACTORS 2023; 65:1001-1013. [PMID: 34861791 DOI: 10.1177/00187208211051804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Investigating dual-task (DT) performance during simulated weightlessness by water submersion, using a manual tracking and a choice reaction task. In contrast to previous work, we focus on performance changes over time. BACKGROUND Previous research showed motor tracking and choice reaction impairments under DT and single-task (ST) conditions in shallow water submersion. Recent research analyzed performance as average across task time, neglecting potential time-related changes or fluctuations of task-performance. METHOD An unstable tracking and a choice reaction task was performed for one minute under ST and DT conditions in 5 m water submersion and on dry land in 43 participants. Tracking and choice reaction time performance for both tasks were analyzed in blocks of 10 seconds. RESULTS Tracking performance deteriorated underwater compared to dry land conditions during the second half while performing one minute in DT conditions. Choice reaction time increased underwater as well, but independent of task time and type. CONCLUSION Tracking error increased over time when performing unstable tracking and choice reaction together. Potentially, physiological and psychological alterations under shallow submersion further strain the human system during DT operations, exceeding available recourse capacities such that DT performance deteriorated over time. APPLICATION Humans operating in simulated weightlessness underwater should be aware of substantial performance declines that can occur within a short amount of time during DT situations that include continuous tracking.
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Affiliation(s)
- Marc Dalecki
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA
| | - Fabian Steinberg
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA
| | - Rainer Beurskens
- Fachhochschule des Mittelstandes, University of Applied Sciences, Bielefeld, Germany
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Paganini M, Cantarella G, Cialoni D, Giuffrè E, Bosco G. Feasibility of chest ultrasound up to 42 m underwater. Ultrasound J 2023; 15:34. [PMID: 37603121 PMCID: PMC10441895 DOI: 10.1186/s13089-023-00334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
After recent advancements, ultrasound has extended its applications from bedside clinical practice to wilderness medicine. Performing ultrasound scans in extreme environments can allow direct visualization of unique pathophysiological adaptations but can be technically challenging. This paper summarizes how a portable ultrasound apparatus was marinized to let scientific divers and sonographers perform ultrasound scans of the lungs underwater up to - 42 m. A metallic case protected the ultrasound apparatus inside; a frontal transparent panel with a glove allowed visualization and operation of the ultrasound by the diving sonographer. The inner pressure was equalized with environmental pressure through a compressed air tank connected with circuits similar to those used in SCUBA diving. Finally, the ultrasound probe exited the metallic case through a sealed aperture. No technical issues were reported after the first testing step and the real experiments.
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Affiliation(s)
- Matteo Paganini
- Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, 35131, Padua, Italy.
| | - Giuseppe Cantarella
- Department of Physics, Informatics and Mathematics, University of Modena and Reggio Emilia, Modena, Italy
| | - Danilo Cialoni
- Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, 35131, Padua, Italy
| | | | - Gerardo Bosco
- Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, 35131, Padua, Italy
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Castagna O, Druelle A, Michoud G, Prevautel T, Lacour JR. Individual Changes in Respiratory Compliance Upon Immersion May Predict Susceptibility to Immersion Pulmonary Edema. SPORTS MEDICINE - OPEN 2023; 9:39. [PMID: 37261587 PMCID: PMC10234985 DOI: 10.1186/s40798-023-00590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Immersion pulmonary edema (IPE) is a frequent diving accident, and it is the primary cause of hospitalization for young military divers during training. The objective of this study was to identify immersion-induced parameters predicting individual susceptibility to IPE. METHODS Eighteen experienced male divers having completed at least 100 dives were recruited. Eight divers had previously been hospitalized for IPE (IPE), and the other ten had never developed IPE (non-IPE). The two groups were matched for age, BMI, and number of dives performed. Ventilatory function and overall compliance of the respiratory system (Crs) were measured on land and during head-out-of-water immersion. Subjects also performed 30 min of fin swimming in a channel at 33 m min-1. Following this exercise, the presence of extravascular lung water, revealed by ultrasound lung comets (ULC), was assessed. RESULTS In the whole group, the decrease in Crs upon immersion correlated with the immersion-induced alterations to expiratory reserve volume, ERV (r2 = 0.91; p < 0.001), inspiratory reserve volume, IRV (r2 = 0.94; p < 0.001), and tidal volume, Vt, changes (r2 = 0.43; p < 0.003). The number of ULC correlated strongly with immersion-induced changes in ventilatory function (r2 = 0.818; p < 0.001 for ERV, r2 = 0.849; p < 0.001 for IRV, r2 = 0.304; p = 0.0164 for Vt) and reduced Crs (r2 = 0.19; p < 0.001). The variations of ERV, IRV, and Crs at rest induced by head-out-of-water immersion and the number of ULC measured after swimming for 30 min were significantly greater in IPE subjects. CONCLUSION In the face of similar immersion stresses, the extent of alterations to ventilatory function and the number of ULCs were very different between individuals but remained statistically correlated. These parameters were significantly greater in divers with a history of IPE. Alterations to pulmonary function and, in particular, to pulmonary compliance induced by head-out-of-water immersion, through their effects on work of breathing appear to allow the identification of divers with a greater susceptibility to developing IPE. Measurement of these parameters could therefore be proposed as a predictive test for the risk of developing IPE.
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Affiliation(s)
- Olivier Castagna
- Underwater Research Team – ERRSO, Military Biomedical Research Institute-IRBA, Toulon, France
- LAMHESS (UPR 6312), Université de Nice, Nice, France
| | | | | | - Thibaut Prevautel
- Department of Cardiology, Laveran Military Hospital (HIA Laveran), Marseille, France
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Peppas S, Palaiodimos L, Nagraj S, Kokkinidis DG, Tiwari N, Kharawala A, Mojadidi MK, Mojaddedi S, Ntaios G, Faillace RT, Tobis JM. Right-to-Left Shunt in Divers with Neurological Decompression Sickness: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:1407. [PMID: 37239692 PMCID: PMC10217987 DOI: 10.3390/healthcare11101407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the association between the presence of a right-to-left shunt (RLS) and neurological decompression sickness (NDCS) and asymptomatic brain lesions among otherwise healthy divers. BACKGROUND Next to drowning, NDCS is the most severe phenotype of diving-related disease and may cause permanent damage to the brain and spinal cord. Several observational reports have described the presence of an RLS as a significant risk factor for neurological complications in divers, ranging from asymptomatic brain lesions to NDCS. METHODS We systematically reviewed the MEDLINE, Embase, and CENTRAL databases from inception until November 2021. A random-effects model was used to compute odds ratios. RESULTS Nine observational studies consisting of 1830 divers (neurological DCS: 954; healthy divers: 876) were included. RLS was significantly more prevalent in divers with NDCS compared to those without (62.6% vs. 27.3%; odds ratio (OR): 3.83; 95% CI: 2.79-5.27). Regarding RLS size, high-grade RLS was more prevalent in the NDCS group than the no NDCS group (57.8% versus 18.4%; OR: 4.98; 95% CI: 2.86-8.67). Further subgroup analysis revealed a stronger association with the inner ear (OR: 12.13; 95% CI: 8.10-18.17) compared to cerebral (OR: 4.96; 95% CI: 2.43-10.12) and spinal cord (OR: 2.47; 95% CI: 2.74-7.42) DCS. RLS was more prevalent in divers with asymptomatic ischemic brain lesions than those without any lesions (46.0% vs. 38.0%); however, this was not statistically significant (OR: 1.53; 95% CI: 0.80-2.91). CONCLUSIONS RLS, particularly high-grade RLS, is associated with greater risk of NDCS. No statistically significant association between RLS and asymptomatic brain lesions was found.
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Affiliation(s)
- Spyros Peppas
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Sanjana Nagraj
- Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Damianos G. Kokkinidis
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, New Haven, CT 06520, USA
| | - Nidhish Tiwari
- Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Amrin Kharawala
- Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Mohammad K. Mojadidi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Sanauallah Mojaddedi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 382 21 Larissa, Greece
| | - Robert T. Faillace
- Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Jonathan M. Tobis
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Kauling RM, Rienks R, Cuypers JAAE, Jorstad HT, Roos-Hesselink JW. SCUBA Diving in Adult Congenital Heart Disease. J Cardiovasc Dev Dis 2023; 10:20. [PMID: 36661915 PMCID: PMC9863475 DOI: 10.3390/jcdd10010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023] Open
Abstract
Conventionally, scuba diving has been discouraged for adult patients with congenital heart disease (ACHD). This restrictive sports advice is based on expert opinion in the absence of high-quality diving-specific studies. However, as survival and quality of life in congenital heart disease (CHD) patients have dramatically improved in the last decades, a critical appraisal whether such restrictive sports advice is still applicable is warranted. In this review, the cardiovascular effects of diving are described and a framework for the work-up for ACHD patients wishing to engage in scuba diving is provided. In addition, diving recommendations for specific CHD diagnostic groups are proposed.
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Affiliation(s)
- Robert M. Kauling
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Rienk Rienks
- CardioExpert Clinic for Sports and Occupational Cardiology, 1087 DK Amsterdam, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Judith A. A. E. Cuypers
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Harald T. Jorstad
- Department of Cardiology, Heart Center, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
| | - Jolien W. Roos-Hesselink
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
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11
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Eight Aging-Related Genes Prognostic Signature for Cervical Cancer. Int J Genomics 2023; 2023:4971345. [PMID: 36880057 PMCID: PMC9985510 DOI: 10.1155/2023/4971345] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/26/2022] [Accepted: 01/13/2023] [Indexed: 02/27/2023] Open
Abstract
This study searched for aging-related genes (ARGs) to predict the prognosis of patients with cervical cancer (CC). All data were obtained from Molecular Signatures Database, Cancer Genome Atlas, Gene Expression Integration, and Genotype Organization Expression. The R software was used to screen out the differentially expressed ARGs (DE-ARGs) between CC and normal tissues. A protein-protein interaction network was established by the DE-ARGs. The univariate and multivariate Cox regression analyses were conducted on the first extracted Molecular Complex Detection component, and a prognostic model was constructed. The prognostic model was further validated in the testing set and GSE44001 dataset. Prognosis was analyzed by Kaplan-Meier curves, and accuracy of the prognostic model was assessed by receiver operating characteristic area under the curve analysis. An independent prognostic analysis of risk score and some clinicopathological factors of CC was also performed. The copy-number variant (CNV) and single-nucleotide variant (SNV) of prognostic ARGs were analyzed by the BioPortal database. A clinical practical nomogram was established to predict individual survival probability. Finally, we carried out cell experiment to further verify the prognostic model. An eight-ARG prognostic signature for CC was constructed. High-risk CC patients had significantly shorter overall survival than low-risk patients. The receiver operating characteristic (ROC) curve validated the good performance of the signature in survival prediction. The Figo_stage and risk score served as independent prognostic factors. The eight ARGs mainly enriched in growth factor regulation and cell cycle pathway, and the deep deletion of FN1 was the most common CNV. An eight-ARG prognostic signature for CC was successfully constructed.
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„Cardiovascular Top Three” - Can Patients with the Most Common Cardiovascular Conditions Become Candidates for Recreational Scuba Diving? POLISH HYPERBARIC RESEARCH 2022. [DOI: 10.2478/phr-2020-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Cardiovascular diseases such as coronary artery disease, hypertension, and diabetes are some of the most common conditions among the population. An ever-increasing number of recreational divers forces us to consider the impact on unprepared diving patients with cardiovascular diseases, in whom profound changes occur during the dive. People in at-risk groups should have a medical check-up before diving to minimise the risk of possible complications.
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Global longitudinal strain assessment of cardiac function and extravascular lung water formation after diving using semi-closed circuit rebreather. Eur J Appl Physiol 2022; 122:945-954. [DOI: 10.1007/s00421-022-04887-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
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Rives S, Schmid B, Chaumet G, Brégeon F, Boussuges A. Changes in Diaphragmatic Function Induced by an Increased Inspiratory Load Experienced by Military Divers: An Ultrasound Study. Front Physiol 2021; 12:756533. [PMID: 34916955 PMCID: PMC8670941 DOI: 10.3389/fphys.2021.756533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Inspiratory loading is experienced by military divers when they use rebreather device. Our objective was to assess the changes in diaphragm function induced by an increase in inspiratory load at values similar to those experienced by divers in real life. Methods: We recorded the excursion and the thickness of the right hemidiaphragm in 22 healthy male volunteers under inspiratory load conditions, using ultrasound in B- and M-mode. The measurements were performed at tidal volume and during breathing at 50% of inspiratory capacity. The breathing rate was regulated and similar in the various sessions with and without load. Results: The rebreather device used by French military divers leads to an increase in inspiratory load of close to 30 cmH2O. Consequently, the session under load was performed using a device set to this threshold. Significant increases in the excursion and the thickening fraction of the diaphragm were observed between the sessions at tidal volume and at high volume. With addition of the inspiratory load, the excursion of the right hemidiaphragm increased significantly from 2.3 to 3.4cm at tidal volume and from 3.9 to 4.7cm at high volume. The thickening fraction increased significantly from 30.4 to 76.6% at tidal volume and from 70 to 123% at high volume. The statistical analysis demonstrated that assessment of the changes of the thickening fraction during breathing at tidal volume was the most relevant marker to assess the impact of the inspiratory load on the diaphragm. Conclusion: Diaphragm ultrasound can be used to assess the changes in the diaphragm contraction pattern secondary to an increase in the respiratory load that can be generated by use a diving apparatus. The recording of the changes of the motion, and more importantly of the thickness of the diaphragm, during the breathing cycle is able to provide relevant information regarding the inspiratory load.
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Affiliation(s)
- Sarah Rives
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE, Aix Marseille Université, Marseille, France
| | - Bruno Schmid
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France
| | | | - Fabienne Brégeon
- Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHIIHU-Méditerranée Infection, Marseille, France
| | - Alain Boussuges
- ERRSO, Institut de Recherche Biomédicale des Armées (IRBA), Toulon, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRAE, Aix Marseille Université, Marseille, France.,Service d'Explorations Fonctionnelles Respiratoires, CHU Nord, Assistance Publique des Hôpitaux de Marseille et Aix Marseille Univ, IRD, APHM, MEPHIIHU-Méditerranée Infection, Marseille, France
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15
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Tso JV, Powers JM, Kim JH. Cardiovascular considerations for scuba divers. Heart 2021; 108:1084-1089. [PMID: 34670825 DOI: 10.1136/heartjnl-2021-319601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022] Open
Abstract
As the popularity of scuba diving increases internationally, physicians interacting with divers in the clinical setting must be familiar with the cardiovascular stresses and risks inherent to this activity. Scuba presents a formidable cardiovascular challenge by combining unique environmental conditions with the physiologic demands of underwater exercise. Haemodynamic stresses encountered at depth include increased hydrostatic pressure leading to central shifts in plasma volume coupled with cold water stimuli leading to simultaneous parasympathetic and sympathetic autonomic responses. Among older divers and those with underlying cardiovascular risk factors, these physiologic changes increase acute cardiac risks while diving. Additional scuba risks, as a consequence of physical gas laws, include arterial gas emboli and decompression sickness. These pathologies are particularly dangerous with altered sensorium in hostile dive conditions. When present, the appropriate management of patent foramen ovale (PFO) is uncertain, but closure of PFO may reduce the risk of paradoxical gas embolism in divers with a prior history of decompression sickness. Finally, similar to other Masters-level athletes, divers with underlying traditional cardiovascular risk should undergo complete cardiac risk stratification to determine 'fitness-to-dive'. The presence of undertreated coronary artery disease, occult cardiomyopathy, channelopathy and arrhythmias must all be investigated and appropriately treated in order to ensure diver safety. A patient-centred approach facilitating shared decision-making between divers and experienced practitioners should be utilised in the management of prospective scuba divers.
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Affiliation(s)
- Jason V Tso
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joshua M Powers
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan H Kim
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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16
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Lippmann J, Taylor DM. Medical conditions in scuba diving fatality victims in Australia, 2001 to 2013. Diving Hyperb Med 2020; 50:98-104. [PMID: 32557410 PMCID: PMC7481113 DOI: 10.28920/dhm50.2.98-104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/18/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This study identified pre-existing medical conditions among scuba diving fatalities in Australia from 2001 to 2013, inclusive, and assessed whether these conditions likely contributed to the deaths. METHODS The National Coronial Information System (NCIS) was searched for scuba diving-related cases during 2001-2013, inclusive. Coronial findings, witness and police reports, medical histories, and autopsy and toxicology reports were scrutinised for pre-existing medical conditions and autopsy findings. Predisposing factors, triggers, disabling agents, disabling injuries and causes of death were analysed using a validated template. RESULTS There were 126 scuba diving-related fatalities identified during the study period. Forty-six (37%) divers were identified as having a significant medical condition which may have contributed to their incident. The most common condition was ischaemic heart disease (IHD) which had been diagnosed in 15 of the divers. Thirty-two (25%) deaths were attributed to cardiac disabling injuries (DI) such as ischaemic heart disease and arrhythmias, although a cardiac DI was thought likely in another six. Respiratory conditions were implicated in eight (6%) deaths, at least four associated with cerebral arterial gas embolism. At least 14 (11%) divers who had contributory pre-existing medical conditions had been cleared to dive by a medical practitioner within the year prior. CONCLUSIONS Chronic health-related factors played a major role in almost half of these deaths; primarily cardiac conditions such as IHD and cardiac arrhythmias. Although fitness-to-dive (FTD) assessments have limitations, the high incidence of cardiac-related deaths indicates a need for 'older' divers to be medically assessed for FTD.
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Affiliation(s)
- John Lippmann
- Australasian Diving Safety Foundation, Canterbury, Victoria, Australia
- Department of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- Corresponding author: Dr John Lippmann, P.O. Box 478, Canterbury VIC 3126, Australia,
| | - David McD Taylor
- Emergency Department, Austin Hospital, Victoria, Australia
- Department of Medicine, Melbourne University, Victoria, Australia
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17
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Gaustad SE, Kondratiev TV, Eftedal I, Tveita T. Continuous Hemodynamic Monitoring in an Intact Rat Model of Simulated Diving. Front Physiol 2020; 10:1597. [PMID: 31998144 PMCID: PMC6970338 DOI: 10.3389/fphys.2019.01597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/19/2019] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular risk is elevated in divers, but detailed information of cardiac function during diving is missing. The aim of this study was to apply an intact rat model with continuous monitoring of cardiac left ventricular (LV) function in a simulated diving experiment. Thirteen rats were inserted with a LV pressure-volume catheter and a pressure transducer in the femoral artery to measure hemodynamic variables, and randomly assigned to diving (n = 9) and control (n = 4) groups. The diving group was compressed to 600 kPa in air, maintained at pressure for 45 min (bottom phase), and decompressed to surface at 50 kPa/min. Data was collected before, during, and up to 60 min after exposure in the diving group, and at similar times in non-diving controls. During the bottom phase, stroke volume (SV) (-29%) and cardiac output (-30%) decreased, whereas LV end-systolic volume (+13%), mean arterial pressure (MAP) (+29%), and total peripheral resistance (TPR) (+72%) increased. There were no changes in LV contractility, stroke work, or diastolic function. All hemodynamic variables returned to baseline values within 60 min after diving. In conclusion, our simulated dive experiment to 600 kPa increased MAP and TPR to levels which caused a substantial reduction in SV and LV volume output. The increase in cardiac afterload demonstrated to take place during a dive is well tolerated by the healthy heart in our model, whereas in a failing heart this abrupt change in afterload may lead to acute cardiac decompensation.
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Affiliation(s)
- Svein E Gaustad
- Møreforskning AS, Ålesund, Norway.,Cardiovascular Research Group, Department of Medical Biology, UiT, The Arctic University of Norway, Tromsø, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Timofei V Kondratiev
- Cardiovascular Research Group, Department of Medical Biology, UiT, The Arctic University of Norway, Tromsø, Norway.,Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Ingrid Eftedal
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torkjel Tveita
- Cardiovascular Research Group, Department of Medical Biology, UiT, The Arctic University of Norway, Tromsø, Norway.,Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.,Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
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18
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Vincenzi FF. Sudden Unexpected Death and the Mammalian Dive Response: Catastrophic Failure of a Complex Tightly Coupled System. Front Physiol 2019; 10:97. [PMID: 30886584 PMCID: PMC6389676 DOI: 10.3389/fphys.2019.00097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/25/2019] [Indexed: 01/02/2023] Open
Abstract
In tightly coupled complex systems, when two or more factors or events interact in unanticipated ways, catastrophic failures of high-risk technical systems happen rarely, but quickly. Safety features are commonly built into complex systems to avoid disasters but are often part of the problem. The human body may be considered as a complex tightly coupled system at risk of rare catastrophic failure (sudden unexpected death, SUD) when certain factors or events interact. The mammalian dive response (MDR) is a built-in safety feature of the body that normally conserves oxygen during acute hypoxia. Activation of the MDR is the final pathway to sudden cardiac (SCD) in some cases of sudden infant death syndrome (SIDS), sudden unexpected death in epilepsy (SUDEP), and sudden cardiac death in water (SCDIW, fatal drowning). There is no single cause in any of these death scenarios, but an array of, unanticipated, often unknown, factors or events that activate or interact with the mammalian dive reflex. In any particular case, the relevant risk factors or events might include a combination of genetic, developmental, metabolic, disease, environmental, or operational influences. Determination of a single cause in any of these death scenarios is unlikely. The common thread among these seemingly different death scenarios is activation of the mammalian dive response. The human body is a complex tightly coupled system at risk of rare catastrophic failure when that "safety feature" is activated.
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Affiliation(s)
- Frank F. Vincenzi
- Department of Pharmacology, University of Washington, Seattle, WA, United States
- Pharmacological Information and Consultation Service, Arlington, WA, United States
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19
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Kozakiewicz M, Slomko J, Buszko K, Sinkiewicz W, Klawe JJ, Tafil-Klawe M, Newton JL, Zalewski P. Acute Biochemical, Cardiovascular, and Autonomic Response to Hyperbaric (4 atm) Exposure in Healthy Subjects. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:5913176. [PMID: 29977313 PMCID: PMC5994282 DOI: 10.1155/2018/5913176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022]
Abstract
The aim of this study was to explore the effect of a hyperbaric environment alone on the cardiovascular system by ensuring elimination of factors that may mask the effect on hyperbaria. The research was performed in a hyperbaric chamber to eliminate the effect of physical activity and the temperature of the aquatic environment. Biochemical analysis and examination with the Task Force Monitor device were performed before and immediately after exposure. TFM was used for noninvasive examination of the cardiovascular system and the functional evaluation of the autonomic nervous system. Natriuretic peptides were measured as biochemical markers which were involved in the regulation of haemodynamic circulation vasoconstriction (urotensin II). L-arginine acted as a precursor of the level of the nitric oxide whereas angiotensin II and angiotensin (1-7) were involved in cardiac remodeling. The study group is comprised of 18 volunteers who were professional divers of similar age and experience. The results shown in our biochemical studies do not exceed reference ranges but a statistically significant increase indicates the hyperbaric environment is not without impact upon the human body. A decrease in HR, an increase in mBP, dBP, and TPR, and increase in parasympathetic heart nerves activity suggest an increase in heart afterload with a decrease in heart activity within almost one hour after hyperbaric exposure. Results confirm that exposure to a hyperbaric environment has significant impact on the cardiovascular system. This is confirmed both by changes in peptides associated with poorer cardiovascular outcomes, where a significant increase in the studied parameters was observed, and by noninvasive examination.
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Affiliation(s)
- Mariusz Kozakiewicz
- Department of Food Chemistry, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Dębowa 3, 85-626 Bydgoszcz, Poland
| | - Joanna Slomko
- Department of Hygiene, Epidemiology and Ergonomics, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Katarzyna Buszko
- Department of Theoretical Foundations of Bio-Medical Sciences and Medical Informatics, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Jagiellonska 13, 85-067 Bydgoszcz, Poland
| | - Wladyslaw Sinkiewicz
- 2nd Department of Cardiology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Ujejskiego 75, 85-168 Bydgoszcz, Poland
| | - Jacek J. Klawe
- Department of Hygiene, Epidemiology and Ergonomics, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Malgorzata Tafil-Klawe
- Department of Human Physiology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Julia L. Newton
- Institute for Ageing and Health, The Medical School, Newcastle University, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK
| | - Pawel Zalewski
- Department of Hygiene, Epidemiology and Ergonomics, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
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20
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The healthy diver: A cross-sectional survey to evaluate the health status of recreational scuba diver members of Divers Alert Network (DAN). PLoS One 2018; 13:e0194380. [PMID: 29566018 PMCID: PMC5864008 DOI: 10.1371/journal.pone.0194380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 02/20/2018] [Indexed: 11/24/2022] Open
Abstract
Background Scuba diver fitness is paramount to confront environmental stressors of diving. However, the diving population is aging and the increasing prevalence of diseases may be a concern for diver fitness. Purpose The purpose of this study is to assess the demographics, lifestyle factors, disease prevalence, and healthcare access and utilization of Divers Alert Network (DAN) members and compare them with those from the general population. Methods DAN membership health survey (DMHS) was administered online in 2011 to DAN members in the United States (US). Health status of DMHS respondents was compared with the general US population data from the Center for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System using two-sided student’s t-tests and Mantel-Haenszel chi-square tests. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with healthcare utilization among the DMHS participants. Results Compared to the general US population, the DMHS population had lower prevalence of asthma, heart attack, angina, stroke, diabetes, hypertension, hypercholesterolemia, and disabilities (p<0.01); more heavy alcohol drinkers, and fewer smokers (p<0.01); and greater access and utilization (routine checkup) of healthcare (p<0.01). Healthcare utilization in males was lower than among females. Increasing age and increase in the number of chronic illnesses were associated with increased healthcare utilization. Conclusions DAN members are healthier than the general US population. DAN members also have better access to healthcare and utilize healthcare for preventive purposes more often than the general population. DAN members appear to have a better fitness level than their non-diving peers.
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21
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Castagna O, Regnard J, Gempp E, Louge P, Brocq FX, Schmid B, Desruelle AV, Crunel V, Maurin A, Chopard R, MacIver DH. The Key Roles of Negative Pressure Breathing and Exercise in the Development of Interstitial Pulmonary Edema in Professional Male SCUBA Divers. SPORTS MEDICINE-OPEN 2018; 4:1. [PMID: 29299780 PMCID: PMC5752643 DOI: 10.1186/s40798-017-0116-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/17/2017] [Indexed: 12/12/2022]
Abstract
Background Immersion pulmonary edema is potentially a catastrophic condition; however, the pathophysiological mechanisms are ill-defined. This study assessed the individual and combined effects of exertion and negative pressure breathing on the cardiovascular system during the development of pulmonary edema in SCUBA divers. Methods Sixteen male professional SCUBA divers performed four SCUBA dives in a freshwater pool at 1 m depth while breathing air at either a positive or negative pressure both at rest or with exercise. Echocardiography and lung ultrasound were used to assess the cardiovascular changes and lung comet score (a measure of interstitial pulmonary edema). Results The ultrasound lung comet score was 0 following both the dives at rest regardless of breathing pressure. Following exercise, the mean comet score rose to 4.2 with positive pressure breathing and increased to 15.1 with negative pressure breathing. The development of interstitial pulmonary edema was significantly related to inferior vena cava diameter, right atrial area, tricuspid annular plane systolic excursion, right ventricular fractional area change, and pulmonary artery pressure. Exercise combined with negative pressure breathing induced the greatest changes in these cardiovascular indices and lung comet score. Conclusions A diver using negative pressure breathing while exercising is at greatest risk of developing interstitial pulmonary edema. The development of immersion pulmonary edema is closely related to hemodynamic changes in the right but not the left ventricle. Our findings have important implications for divers and understanding the mechanisms of pulmonary edema in other clinical settings.
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Affiliation(s)
- Olivier Castagna
- Underwater Research Team (ERRSO) from the Military Biomedical Research Institute (IRBA), Toulon, France.,Laboratory of Human Motricity, Education Sport and Health, LAMHESS (EA 6312), Toulon, France
| | - Jacques Regnard
- EA3920, University Bourgogne Franche-Comté and University Hospitals, Besançon, France
| | | | - Pierre Louge
- Department of Hyperbaric Medicine, HIA St Anne Military Hospital, Toulon, France
| | | | - Bruno Schmid
- Underwater Research Team (ERRSO) from the Military Biomedical Research Institute (IRBA), Toulon, France
| | - Anne-Virginie Desruelle
- Underwater Research Team (ERRSO) from the Military Biomedical Research Institute (IRBA), Toulon, France
| | - Valentin Crunel
- Underwater Research Team (ERRSO) from the Military Biomedical Research Institute (IRBA), Toulon, France
| | - Adrien Maurin
- Underwater Research Team (ERRSO) from the Military Biomedical Research Institute (IRBA), Toulon, France
| | - Romain Chopard
- Department of Cardiology EA3920, Franche Comté University and University Hospital, Besançon, France
| | - David Hunter MacIver
- Biological Physics Group, University of Manchester, Manchester, UK. .,Musgrove Park, Taunton & Somerset Hospital, Taunton, UK.
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22
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Cibis T, McEwan A, Sieber A, Eskofier B, Lippmann J, Friedl K, Bennett M. Diving Into Research of Biomedical Engineering in Scuba Diving. IEEE Rev Biomed Eng 2017; 10:323-333. [PMID: 28600260 DOI: 10.1109/rbme.2017.2713300] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The physiologic response of the human body to different environments is a complex phenomenon to ensure survival. Immersion and compressed gas diving, together, trigger a set of responses. Monitoring those responses in real time may increase our understanding of them and help us to develop safety procedures and equipment. This review outlines diving physiology and diseases and identifies physiological parameters worthy of monitoring. Subsequently, we have investigated technological approaches matched to those in order to evaluated their capability for underwater application. We focused on wearable biomedical monitoring technologies, or those which could be transformed to wearables. We have also reviewed current safety devices, including dive computers and their underlying decompression models and algorithms. The review outlines the necessity for biomedical monitoring in scuba diving and should encourage research and development of new methods to increase diving safety.
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23
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Cardiovascular Mechanisms of Extravascular Lung Water Accumulation in Divers. Am J Cardiol 2017; 119:929-932. [PMID: 28189252 DOI: 10.1016/j.amjcard.2016.11.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/22/2022]
Abstract
This study assessed the relation between altered cardiac function and the development of interstitial pulmonary edema in scuba divers. Fifteen healthy men performed a 30-minute scuba dive in open sea. They were instructed to fin for 30 minutes and were wearing wet suits. Before and immediately after immersion, cardiac indexes and extravascular lung water were measured using echocardiography and lung ultrasound, respectively. The mean ultrasound lung comet score increased from 0 to 4.6 ± 3.4. The diameter of the inferior caval vein increased by 47 ± 5.2%, systolic pulmonary artery pressure by 105 ± 8.6%, left atrial volume by 18.0 ± 3.3%, and left ventricle end-diastolic volume by 10 ± 2.4% suggesting that both right and left ventricular (LV) filling pressures were elevated. Doppler studies showed an increased mitral E peak (+2.5 ± 0.3%) and E/A ratio (+22.5 ± 3.4%) with a decreased mitral A peak (-16.4 ± 2.7%), E peak deceleration time (-14.5 ± 2.4%) consistent with rapid early LV filling but without a change in LV stroke volume. There was an increase in right/left ventricle diameter ratio (+33.6 ± 4.8%) suggesting a relative increase in right-sided heart output compared with the left. Furthermore, the lung comet score correlated significantly with inferior caval vein diameter, systolic pulmonary artery pressure, right/left ventricle diameter ratio, and E-wave deceleration time. In conclusion, the altered right/left heart stroke volume balance could play an essential role in the development of immersion pulmonary edema. Our findings have important implications for the pathogenesis of cardiogenic pulmonary edema.
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25
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26
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Patent Foramen Ovale in Recreational and Professional Divers: An Important and Largely Unrecognized Problem. Can J Cardiol 2015; 31:1061-6. [PMID: 26143138 DOI: 10.1016/j.cjca.2015.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/10/2015] [Accepted: 03/10/2015] [Indexed: 11/20/2022] Open
Abstract
Patent foramen ovale (PFO) is associated with an increased risk of decompression sickness (DCS) in divers that results from a paradoxical embolization of nitrogen bubbles. The number of scuba divers worldwide is estimated in the millions, and the prevalence of PFO is 25%-30% in adults. It is interesting that despite these numbers, many important issues regarding optimal screening, risk stratification, and management strategy still remain to be resolved. Recently published data suggest the possible effectiveness of both PFO closure and conservative diving measures in preventing arterial gas embolization. This review aims to introduce the basic principles of physiology and the pathophysiology of bubble formation and DCS, summarize the current literature on PFO and diving, and review the possibilities of diagnostic workup and management.
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27
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Bondke Persson A, Persson PB. Extreme environments. Acta Physiol (Oxf) 2014; 212:189-90. [PMID: 25042108 DOI: 10.1111/apha.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Bondke Persson
- Institute of Vegetative Physiology; Charité-Universitaetsmedizin Berlin; Berlin Germany
| | - P. B. Persson
- Institute of Vegetative Physiology; Charité-Universitaetsmedizin Berlin; Berlin Germany
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28
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Bondke Persson A, Persson PB. Form and function in the vascular system. Acta Physiol (Oxf) 2014; 211:468-70. [PMID: 24800879 DOI: 10.1111/apha.12309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- A. Bondke Persson
- Institute of Vegetative Physiology; Charité-Universitaetsmedizin Berlin; Berlin Germany
| | - P. B. Persson
- Institute of Vegetative Physiology; Charité-Universitaetsmedizin Berlin; Berlin Germany
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29
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Honěk J, Srámek M, Sefc L, Januška J, Fiedler J, Horváth M, Tomek A, Novotný S, Honěk T, Veselka J. Effect of catheter-based patent foramen ovale closure on the occurrence of arterial bubbles in scuba divers. JACC Cardiovasc Interv 2014; 7:403-8. [PMID: 24630875 DOI: 10.1016/j.jcin.2013.12.199] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/29/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study sought to evaluate the effect of catheter-based patent foramen ovale (PFO) closure on the occurrence of arterial bubbles after simulated dives. BACKGROUND PFO is a risk factor of decompression sickness in divers due to paradoxical embolization of bubbles. To date, the effectiveness of catheter-based PFO closure in the reduction of arterial bubbles has not been demonstrated. METHODS A total of 47 divers (age 35.4 ± 8.6 years, 81% men) with a PFO (PFO group) or treated with a catheter-based PFO closure (closure group) were enrolled in this case-controlled observational trial. All divers were examined after a simulated dive in a hyperbaric chamber: 34 divers (19 in the PFO group, 15 in the closure group) performed a dive to 18 m for 80 min, and 13 divers (8 in the PFO group, 5 in the closure group) performed a dive to 50 m for 20 min. Within 60 min after surfacing, the presence of venous and arterial bubbles was assessed by transthoracic echocardiography and transcranial color-coded sonography, respectively. RESULTS After the 18-m dive, venous bubbles were detected in 74% of divers in the PFO group versus 80% in the closure group (p = 1.0), and arterial bubbles were detected in 32% versus 0%, respectively (p = 0.02). After the 50-m dive, venous bubbles were detected in 88% versus 100%, respectively (p = 1.0), and arterial bubbles were detected in 88% versus 0%, respectively (p < 0.01). CONCLUSIONS No difference was observed in the occurrence of venous bubbles between the PFO and closure groups, but the catheter-based PFO closure led to complete elimination of arterial bubbles after simulated dives. (Nitrogen Bubble Detection After Simulated Dives in Divers With PFO and After PFO Closure; NCT01854281).
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Affiliation(s)
- Jakub Honěk
- Department of Cardiology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Pathological Physiology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Martin Srámek
- Institute of Pathological Physiology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic; Department of Neurology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Luděk Sefc
- Institute of Pathological Physiology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | | | - Jiří Fiedler
- Department of Cardiology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Martin Horváth
- Department of Cardiology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Aleš Tomek
- Department of Neurology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Stěpán Novotný
- Hyperbaric Chamber, Kladno Regional Hospital, Kladno, Czech Republic
| | - Tomáš Honěk
- Department of Cardiology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Josef Veselka
- Department of Cardiology, Charles University in Prague, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.
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Boussuges A, Rostain JC. What cardiovascular changes during SCUBA diving? Acta Physiol (Oxf) 2013; 209:9-10. [PMID: 23764211 DOI: 10.1111/apha.12136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - J.-C. Rostain
- UMR MD2; Aix Marseille University (AMU); Marseille; France
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