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Acute coronary syndrome and decompression illness: a challenge for the diving physician
Marco Brauzzi1, Fabio Andreozzi2, Laura De Fina3
1Hyperbaric Medicine Unit, Niguarda Hospital, Milan, Via del Commendone 42, 58100 Grosseto, Italy, Phone and Fax: +39-(0)5-6445-0434,
Insights
Cardiac symptoms in divers are rare but can mimic acute coronary syndromes. Prompt recompression is crucial for decompression illness (DCI), even with cardiac presentations, to avoid treatment delays.
Area of Science:
- Cardiology
- Diving Medicine
- Emergency Medicine
Background:
- Decompression illness (DCI) presents with varied symptoms, but cardiac manifestations are uncommon.
- Differentiating DCI from acute coronary syndromes (ACS) is critical, as ACS requires immediate intervention, potentially delaying DCI treatment.
Observation:
- Three cases of divers presenting with cardiac symptoms are detailed.
- Case 1: A 48-year-old woman experienced loss of consciousness post-dive, diagnosed with acute myocardial infarction, and did not receive recompression.
- Case 2: A 27-year-old man developed tachycardia, dyspnea, and vertigo post-dive, diagnosed with new-onset atrial fibrillation; recompression resolved vertigo, and sinus rhythm was restored.
- Case 3: A 43-year-old man with prior coronary artery bypass grafting experienced chest pain and arm numbness after a dive; negative cardiac workup and subsequent recompression led to symptom resolution.
Findings:
- Cardiac symptoms in divers can be challenging to diagnose.
- Recompression therapy can be effective even in the presence of cardiac symptoms suggestive of DCI.
- Timely differential diagnosis is essential to guide appropriate management, balancing DCI treatment with potential cardiac emergencies.
Implications:
- Highlights the importance of considering DCI in divers with cardiac symptoms.
- Emphasizes that cardiac symptoms should not automatically preclude recompression therapy for suspected DCI.
- Suggests a need for clear diagnostic pathways to differentiate DCI from ACS in diving populations to ensure optimal patient outcomes.
Abstract:
Decompression illness (DCI) is a syndrome with diverse clinical manifestations but in which cardiac symptoms are rare. In the presence of cardiac symptoms, the necessity to rule out an acute coronary syndrome (ACS) which requires prompt treatment may result in delay to appropriate recompression treatment. We describe three cases with cardiologic symptoms referred to our centre by the Emergency Department (ED) of our facility. The first was a 48-year-old woman who lost consciousness during a dive and required cardiopulmonary resuscitation. The final diagnosis was acute myocardial infarction and the patient did not undergo recompression treatment. The second case was that of a 27-year-old man who complained of tachycardia, dyspnoea and vertigo soon after a dive. He was referred by helicopter ambulance and in the ED was diagnosed with new-onset atrial fibrillation. Recompression resulted in disappearance of his vertigo, and sinus rhythm was restored pharmacologically. The third case was a 43-year-old man, with a history of coronary artery disease, who had undergone coronary artery bypass grafting three years previously. After a repetitive dive without adequate decompression, he complained of crushing retrosternal pain and numbness in the upper left arm. All cardiovascular examinations were negative and the patient was recompressed, with resolution of his symptoms. Features to consider in arriving at the correct differential diagnosis in divers presenting with cardiac symptoms are discussed in the light of these three illustrative cases.
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