Cardiovascular Disease and Diving

Q: I had a stent placed earlier this year. My cardiologist is satisfied with the  results and has cleared me to return to diving. The dive resort for my upcoming trip wants confirmation that the medications I’m taking are safe for diving. My doctor prescribed Brilinta (ticagrelor), Lasix (furosemide), Altace (ramipril),  Zocor (simvastatin) and Toprol (metoprolol). I am 62 years old and have been diving for 34 years.

Unfortunately your question doesn’t have a one-size-fits-all answer. The most important thing to understand is that doctors do not evaluate medications for safety; they evaluate the diver. The question is not “Are my medications safe?” but rather “Am I safe to dive?” Although medications are an important consideration when determining your fitness to dive, it is often the underlying condition for which you take the medications that you and your doctor need to evaluate in detail. Medication side effects may be a concern for diving, but the underlying diagnosis should be the focus when deciding someone’s fitness to dive. Cardiovascular conditions need careful evaluation that may require input from both the cardiologist and dive medicine physician.

Compressed-gas diving introduces significant changes to the diver’s physiology that the body doesn’t experience with land-based sports. According to the 2018 edition of DAN’s Annual Diving Report, cardiac disease is the leading suspected cause of death for divers 50 years old and older while diving. A fitness decision for someone to return to regular exercise activities does not necessarily equate to whether someone is fit to dive.

The medications you listed are indicative of cardiovascular disease. While cardiovascular disease alone does not prevent you from diving, the extent of the disease may. Multiple medications may indicate multiple conditions that require control to minimize a heart attack or stroke. Any one medication is generally not an issue provided the condition is well-controlled, and your doctor needs to determine if diving would be a relatively safe activity for you. Your physician may want additional information such as exercise stress testing or even an echocardiogram to make that determination.

DAN is available to consult with doctors and discuss risk factors specific to diving so they can make an informed decision about your ability to dive safely. We want everyone to enjoy diving but not at the risk of a possible bad  outcome from an otherwise preventable event.
— Lana P. Sorrell, MBA, DMT