CARDIOVASCULAR
DRUGS AND DIVING
Guidelines to
use in considering the relationships between all drugs and diving:
- Consider the condition/illness/disease
for which the medication is being given. Go to our 'Fitness
to Dive' web page and check to see if your condition could be
dangerous
underwater.
- Are there any
effects
of the drug that alter consciousness or
cause
alteration in decision making ability.
- Check in the
linked
'Databases' below for any side effects
of the drug that could be dangerous underwater.
- Consider
complex relationships
between drugs, the individual, other medications, diet and the
conditions
for which the drugs are taken.
- Write us if
you still
have a problem finding or deciding about a specific drug, condition or
drug combination after using the process above.
Use these Databases to Search for Your
Medication, then apply the above diving factors in your decision to
dive!
Many sport diving candidates are taking
a variety of cardiac and blood pressure medications. It is therefore
necessary
to understand the response of patients taking such medications to
exercise
and diving.
Antihypertensives
Poor response to exercise and fainting
are two things that can happen to patients on large doses of
antihypertensive
medication. This is due to the loss of normal control mechanisms of the
vascular system. Because of these effects, diving candidates using
these
drugs exercise tests to rule out inadequate blood pressure response
during
exercise. Limitations to moderate exercise due to dyspnea, weakness,
dizziness
or palpitations should alert the physician to do careful exercise
screening
prior to approval for diving.
Beta blockers
Patients taking beta adrenergic
blocking
drugs may also have unique problems with exercise. Some of these
patients may
have
significant
inability of the heart to respond to exercise; therefore,
measurement
of heart rate does not provide the index of exercise work load which is
generally found in the patients who have normal autonomic
responsiveness. Individuals who are in good physical condition should
generally have little problem with recreational diving while on this
drug.
When stress testing a patient on beta
blockade,
a relative maximum heart rate can be achieved by comparing the
perceived
exercise score with the heart rate when the patient has significant
fatigue.
Heart rate response to exercise however, does not indicate a poor
physiologic
response in this case. There is some suggestion that beta
adrenergic blockade will inhibit maximum exercise performance.
Diving should not provoke maximum work
demand. However, it is important to advise divers taking beta blockers
to avoid extreme exercise since their maximum capacity may by inhibited
by beta blockade. Exercise testing should be done while taking the beta
blocker and in the presence of the usual therapeutic regimen. Patients
on nitrate medications for coronary disease generally have severe
enough
coronary disease that they should not dive.
Beta blockers can also be asociated
with bronchial constriction, an increased risk factor with diving.
Statins
These drugs do not contravene diving per
se, but should indicate to the diver and his physician that there might
be some possibility of
coronary artery disease
- which is a definite risk to the diver.
Important
cardiovascular
medications and diving
Drug
|
Adverse Effect
|
Antiarrhythmics
|
Disease process
Lung fibrosis with amiodarone
|
Antibiotics
|
disease
process (photosensitivity
with with tetracyclines) |
| Anti-hypertensives |
Syncope |
Aspirin
|
Increased bleeding
|
Beta Blockers
|
Decreased
exercise capacity
Reynauds
phenomenon
Bronchial constriction
|
Coumadin
|
Bleeding with barotrauma,
possible worsening of spinal DCS
|
Digitalis
|
disease process
|
Diuretics
|
dehydration, increased risk for
DCS
|
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