[The heart and underwater diving]

Abstract

Cardiovascular examination of a certain number of candidates for underwater diving raises justifiable questions of aptitude. An indicative list of contraindications has been proposed by the French Federation of Underwater Studies and Sports but a physiopathological basis gives a better understanding of what is involved. During diving, the haemodynamic changes due not only to the exercise but also to cold immersion, hyperoxaemia and decompression impose the absence of any symptomatic cardiac disease. Moreover, the vasoconstriction caused by the cold and hyperoxaemia should incite great caution in both coronary and hypertensive patients. The contraindication related to betablocker therapy is controversial and the debate has not been settled in France. The danger of drowning makes underwater diving hazardous in all pathologies carrying a risk of syncope. Pacemaker patients should be carefully assessed and the depth of diving limited. Finally, the presence of right-to-left intracardiac shunts increases the risk of complications during decompressionand contraindicates underwater diving. Patent foramen ovale is a special case but no special investigation is required for its detection. The cardiologist examining candidates for underwater diving should take all these factors into consideration because, although underwater diving is a sport associated with an increased risk, each year there are more and more people, with differing degrees of aptitude, who wish to practice it.