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
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
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
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
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.
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.
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.
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.
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
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.
by Nigel Hewitt