A Heart Attack with special reference to scuba diving

Lets start with the story
It was 4th April 2001. I was 51. It was about five o'clock on a Wednesday morning when I awoke from sleep with a funny pain. I get a lot of funny pains but this one was weird. It felt like a pulled muscle and it ran from elbow to elbow across my chest. However when I waved my arms about it didn't change.

Of course all that waving about disturbed my wife who was medically trained (BSc. Hons. Podiatry from Leaf Hospital, SRCh, Member of..., lots of general medicine as well). She listened, moved me down stairs and phoned the NHS direct phone line. They listened and said that they were sending an ambulance. She immediately fed me an Aspirin as it is a blood thinner and is first aid in these cases.

The ambulance crew arrived and walked in with a defib box. A few measurements. Blood pressure through the roof and heart racing. A quick trip to casualty - the full blue light treatment. Casualty said Angina (pain from heart muscle normally caused by poor blood supply) and held me all that day and then overnight sent me off to a ward.

Next morning, now Friday, in the ward's day room, I am talking to my wife about how they would probably release me shortly when the pain came back. We walked to the desk in the ward and as I start to explain I was jumped on by the nursing staff, wheel chaired to my bed, wired back to the ECG (Electro Cardio Graph - the device to monitor the workings of your heart), dosed with GTN (Glycerol Tri-Nitrate), a vasodilator designed to make your blood vessels relax and expand to make the blood flow much easier and put me on an oxygen mask.

Now I admit I was beginning to lose track. They had already decided I had heart trouble and suddenly it was back. The medical team were running about and my wife, who was keeping out of the way, commented at one point in a rather distressed voice "His lips have gone blue". The physicist in me gulped and reasoned "That's it. It's stopped. Consciousness is now running on what oxygen is left in the blood vessels. Seconds to go..." I did the deep breathing to get the oxygen from the mask in but was wondered what it was going to feel like.

Knowing you could be dead in a few seconds certainly does clarify your mind. I'm not bothered about being dead but I'm not looking forward to the transition out of this life any more than anybody else. This felt like it could easily be that moment. I was scared. Scared big time. Fortunately I couldn't do anything other than sit there and breathe and that must have been the right thing to do as the pain subsided, the blood oxygen rose and they put me into the bed.

Now I had timed it very well. The consultant was in mid rounds and stepped in. He wasn't looking at me but at the ECG print out. When he left the doctor in charge sat down and said "We've changed your diagnosis. It's not Angina. You are having a heart attack and you are having it now." It is nice to know what is going on but I didn't feel hugely reassured by this.

So they went to make arrangements and left me on Oxygen to talk to my wife. Unfortunately they also took the opportunity to get a little food and drink into me so when they came back and said they had made a slot for me in the Cardiac Lab they couldn't work on me until that had gone down.

The ride across the campus to the Cardiac Unit in the main tower building at the Sussex County Hospital was fun. Two big porters arrived and the doctor rewired me to a portable combined ECG and Defib unit. Looking at a box with two big handles on it marked Sternum and Axis was not a happy moment. Then we were off at a run. They clearly did not want me out of the wards and the doctor and my wife were running hard to keep up.

animated stent Five o'clock that evening and I was on the table. A big tube goes into the main artery in the groin, an X-ray sender and camera move over my chest so they can see what is going on and various tools are slid on long wires in at the bottom and up into the heart. When the camera wasn't completely in the way I could see the tubes that injected dye on the screen and I saw some very good looking arteries and one horrible blocked or squashed bit. All the others looked like text book pictures but this one ran across the top of the heart and part way it suddenly made a rounded end (like the twisted off end of an old fashioned sausage I thought at the time) went along a bit as just a wiggly line and then went back to arteries as they should be.

This would have been fascinating if only I wasn't so personally involved. That was the fault and it had already nearly killed me twice.

The job was handed over to the next guy up - the Registrar and he put in a balloon catheter which he poked into the restriction and then blew up to stretch the blood vessel to a more reasonable size (angeoplasty) and the he inserted a little titanium mesh tube which went in small and was also given the balloon treatment to hold the vessel open. Then it was all the usual close down and seal up the holes in the patient stuff.

stent The arterial tube entry point was removed and I was not to be allowed to move for many hours as anything might cause it to open and a leaking main artery is very bad news. Those hours started uncomfortable but my poor tummy was getting dilated with wind and it wouldn't shift. You have no idea how good it is, after five hours, being allowed to rearrange your body so you can break wind into a hospital commode.

Actually from then on it was all plain sailing. They kept me in a few days to see the stent was doing its job then sent me home. I had to take things easy for the first few weeks as I had lost heart muscle and the dead bits needed to scar over so the rest could pull against it and then work back up the strength and stamina. So quite quickly the question of Scuba Diving came up. I'd been diving the previous Saturday.

Now my basic qualifications are PADI and I need to certify myself to train or get a doctor to sign for me but I don't need anything to dive. But was it going to be wise?

Now the first person I asked was the nurse sitting with me to watch after the tubes came out and it turned out she was a diver and she said I would dive again. In weeks. Good start.

So once I was out of hospital I talked to the doctor and he said it seemed reasonable. I waited until I had completed the cardiac rehab course and they were telling me I could resume my life then talked to Margaret, the CD and owner at Newhaven Scuba. She offered the use of her confined water and the loan of a Dive Master to make a very simple start again dive. Dry suit, single cylinder, keep it shallow, keep it simple it was a good dive. This was the 13th May just under six weeks after the heart attack.

The next thing was to get a real diving doctor to OK me. I really wanted this. I wanted to be sure that I wasn't just within the rules but confident that I was not going to have another heart attack in the water and leave some poor buddy wondering what he should have done when it wasn't his fault - it was mine and I should not have been in the sea.

So I went to London and consulted Dr. J. Eden who is a hyperbaric specialist and at the time was on the UK Sports Divers medical Panel. He ECGed me and beat me up on the 18 inch high step up box used for the HSE professional medical and he passed me. Every year I make the trip back and renew it. OK one day I know the Doctor is going to say "I'm sorry Mr. Hewitt but..." and I'm going to have to eBay my fins etc. but I feel confident I am healthier now than say, six months before the heart attack, when I didn't know I had a problem.

A note:
I'm just reviewing this in 2014. I've had a good year's diving and even though I'm 65 now and a widower with the kids grown up and flown the nest I still enjoy getting in the water. That's deep water trimix wreck diving. I bought a new rebreather last Christmas, that's my fourth, and did two diving holidays in the summer. I'm retired now so I can dive when I want. Still on all the tablets and annual medicals. Life is good.


OK so why did I have a heart attack?
I've never smoked. I don't drink. I've been eating low fat and low salt since long before it became trendy. Why? I'm hardly high risk?

There is just one little thing occurs to me. Only a year or so before that I had the slight problem of having a motorbike run over my chest. Well that's what I was told. The story goes that it was the third race of the day and I was exiting turn three at Lydden racing a TZR when there was a contact and several of us were spilled and somebody drove over me. A racing incident. It all ended in a Red Flag. I don't remember any of it as I was stretchered off and dosed with lots of morphine (apparently used to keep the casualty breathing in chest trauma) and that blew my head away. My serious head and chest injuries were downgraded to concussion, a broken collar bone and broken ribs over the next few days which is where my memories fade back in.

This was the accident that ended my Motor Racing as the doctor wasn't in a hurry to sign me as fit and my wife called in the promise that I'd give up when she really wanted me too. However the flat, squeezed bit of the blood vessel did line up nicely where the sternum would have pressed on the heart and a racing motorbike will compress things far more than you do doing CPR. Maybe that was nothing to do with it or maybe it just injured the artery and encouraged stuff to build up there. I don't know and I doubt you can prove anything without taking it out for a look and I'm personally not in favour of the idea of doing that.


Lessons?
Chest pain in a middle aged man, or anybody, are worth worrying about. If I had waited for the pain in the night to go away the second one would not have happened in hospital and I would have surely died. This is what killed my father in-law. He had pains all day and then in the evening virtually dropped dead.

Diving doctors want to help you to go diving. It would have been quite easy for Dr. Eden to say "Heart attack? Give it up" but he tested me to see how my repaired heart responded. It is complicated by the drugs that I shall take for the rest of my days but currently I can deliver the work load and my breathing is not compromised.


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