People who have heart disease in any form are at risk when diving until that condition is treated. Unfortunately, one of the most common forms of treatment for heart disease and other cardiovascular problems is heart surgery. The most common type of heart surgery is bypass surgery, but other forms of heart surgery exist as well, such as valve replacement. Bypass surgery is done to remove or bypass the blocked arteries by using blood vessels that are taken from another part of the body. Valve replacement surgery is used to replace a faulty valve, generally one that has been damaged at some point, often by bacterial infections. Once surgery is used to treat heart disease, the question becomes can a diver go back to diving or can someone begin diving after they have had major heart surgery? The answer to this question depends on the individual situation of each diver.
Heart surgery is a major operation as the chest must be opened for the procedure. There is a significant amount of healing time that is required for the bones to heal and well as the surgical site itself. Divers are cautioned that they must wait six months to a year before returning to diving. There are many doctors who simply will not allow a diver who has undergone heart surgery to return to diving, but there are also those who will allow it if the situation warrants it and it is becoming more and more common for those who are otherwise healthy to go back to diving after heart surgery. It is a very individual decision that ultimately must be made between the diver and his or her cardiologist.
Once the heart surgery has been performed and is successful, then all symptoms of heart disease should be gone and the heart muscle should receive a normal supply of oxygen. If this is the case, then it means that once the patient is fully healed there should be no reason why that person cannot resume diving. One of the main concerns however, is whether or not the heart suffered damage prior to the surgery. This means that the ability of the heart to function post-surgery must be established to ensure that the heart can withstand the stresses of exercise and the stresses imposed by diving.
Once healed from surgery a person must undergo a full cardiovascular exam that will establish the level of cardiovascular health the heart has. This means that during a normal EKG stress test there should be a complete absence of chest pain. This stress test will have the patient run faster and faster, reaching an 8-minute-mile pace briefly, and the patient should be able to perform at a level of 13 mets, which is stage four on the Bruce protocol.
If a person has undergone valve replacement surgery and the new valve is operating properly, then after healing and taking the exercise test described above, the patient should be able to dive without worry. The only concern is with regard to the blood thinning medication that many heart valve replacement patients are on. When the replacement valve is mechanical, blood thinning medication is required to ensure that no blood clots form around the valve. This medication increases the risk of bleeding, which is of particular importance to the diver when it comes to trauma. It is very different when running into problems of trauma and bleeding on dry land than it is when underwater and the risk of death is higher for a diver on blood thinning medication. There is an option to have a pig replacement valve that does not require blood thinning medication, but these wear out faster and must be replaced sooner than mechanical valves.
If there is even the slightest indication that the patient's heart cannot take the stress of exercise, then that person should not dive. However, there are many, many divers who have been diving successfully after heart surgery, so there is a good chance that anyone can do so. After all, it is a common procedure that doctors perform hundreds of times per day. Just be sure to check with your doctor and monitor your healing progress as time goes on. When the time comes for your exercise stress test, do your best and hopefully you will come out ready to dive and with the blessings of your cardiologist. Then you can have fun doing the sport you love once again knowing full well that your heart can take the stress and function properly.