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All the following recommendations and guidelines only apply to sport divers. Any unclear information and further advice should be obtained from your diving physician.


Contents of F.A.Q. in Diving Medicine

1. Cardiovascular Problems
   1. Coronary Artery Disease (CAD)
      Ideally, one would like to establish a baseline and periodic cardiovascular screening program for all divers which would provide laboratory determination of serum lipids, risk factor analysis, resting and exercise electrocardiography and exercise scintigraphy. Scuba diving candidates over the age of 40, and poorly conditioned diving candidates under 40 should have an exercise electrocardiogram. To participate in scuba diving, approximately 14 METS should be achieved. In the presence of an abnormal exercise ECG, such a candidate may be tested with exercise ECG with thallium scintigraphy and, if possible, coronary angiography.
      
      Symptoms of angina pectoris, history or finding of myocardial infarction arrhythmias due to CAD, represent contraindications to diving.
      
      In rare exceptional individuals who undergo successful coronary angioplasty and coronary re-vascularization and those who recover from discrete, non-complicated myocardial infarctions, who have completed rehabilitation programs with life-style and risk-factor modification can be evaluated individually for diving. Return to diving would be only after the usual non-invasive testing procedures by cardiologist to rule out myocardial ischemia.
      
      Regular check-up by cardiologist with experience in diving medicine on an annual basis and maintain a high level of physical conditioning to avoid excess cardiovascular stress in diving.
      
      
   2. Hypertension
      In those who control blood pressure by weight loss, salt restrictions and exercise, diving can be safe. Further, well-controlled by these measures plus diuretics can also continue to dive. Due to the potential need to increase the cardiac output in response to heavy exercise in a diving emergency requires that those taking beta blocking agents or other drugs which produce significant blockade of the nervous system should demonstrate adequate performance on an exercise test to 14 METS. All hypertensive patient with left ventricular hypertrophy, left ventricular dilation or left ventricular dysfunction should not continue diving , even if blood pressure is controlled.
      
      
   3. Valvular Heart Disease
      Mitral regurgitation. If no evidence of left ventricular function and asymptomatic with minimal left ventricular dilation on ECG and echocardiogram that diving can be continue.
      
      Aortic insufficiency. If aortic insufficiency is hemodynamically insignificant and are asymptomatic. The ECG and echocardiogram must show no left ventricular hypertrophy, minimal left ventricular dilation, and no left ventricular dysfunction.
      
      Any degree of aortic stenosis or mitral stenosis is considered disqualifying for diving since they impede forward flow during exercise and pulmonary edema and/or syncope can ensue.
      
      
   4. Congenital Heart Disease
      ANY DEFECT WHICH ALLOWS A COMMUNICATION BETWEEN THE RIGHT AND LEFT CIRCULATIONS AT THE LEVEL OF THE HEART OR GREAT VESSELS SHOULD CAUSE DISQUALIFICATION.
      
      Patients who have had successful repair of non-cyanotic lesions, such as atrial septal defects, patent ductus arteriosus and ventricular septal defect, may be cleared for diving after evaluation by a cardiologist and by a chest physician in view of the required thoracotomy.
      
      
   5. Pacemakers
      In general, patients who require permanent pacemakers are disqualified for diving due to their underlying cardiac disease. The only possible exception to this may be the young individual with congenital third degree A-V block who need full evaluation by their cardiologist to evaluate their functional status and the pacemaker's ability to perform physiologically. Besides, pacemakers have been tested in hyperbaric chambers and showed no change in performance or structural integrity under increased barometric pressure, such tests would be required before considering diving with new pacemakers.
      

   
   
   

2. Pulmonary Problems
   1. Bronchial Asthma
      All exercise-induced asthma is considered an absolute disqualification for scuba diving.
      
      Any patient with currently active bronchial asthma should be strictly forbidden to dive. Any patient with a history of childhood asthma, symptoms suggestive of asthma within the past year, suspicion of exercise or cold air conduced asthma should be referred to a pulmonary medicine specialist for valuation to include challenge testing.
      
      ONE CAUTIOUS REMINDER MUST BE REPEATED: THE GREATEST VOLUME CHANGES IN THE LUNGS OF ANY DIVER WITH AIR TRAPPING OCCUR AT SHALLOW DEPTHS. NEVER CLEAR A PERSON FOR-SHALLOW DIVING ONLY THE SHALLOWEST FOUR FEET, EVEN IN A SWIMMING POOL IS THE MOST DANGEROUS DEPTH FOR COMPRESSED GAS DIVING FOR A PATIENT WITH A BRONCHOSPASTIC DISORDER.
      

   
   
   

3. Endocrinology
   1. Diabetes Mellitus
      No diving for those with insulin dependent diabetes mellitus(IDDM) or with non-insulin dependent diabetes mellitus(NIDDM) if there is a history of hypoglycemic episodes.
      

   
   
   

4. Ophthalmology

   Special considerations regarding common ocular disorders :
   

   1. Glaucoma and Ocular Hypertension
      The existence of glaucoma or ocular hypertension can practice diving as long as adequate visual acuity and visual fields exist. A candidate using Timoptic should be cleared by a cardiologist for diving (the use of Timoptic eye drops can affect the heart rate and response to stress ).
      Diving can continue after a successful Laser trabeculoplasty for treatment of glaucoma .Until further data are available, diving after a filtering bleb should be avoided.
      
      
   2. Retinal detachment
      Repaired or laser photocoagulation in retinal detachment patient can continue diving provided a regular ocular examination by ophthalmologist maintained.
      
      
   3. Cataracts
      Patients with cataracts who still have adequate vision and Aphakia with contact lens correction for visual acuity can dive.
      

   
   
   

5. Neurology
   
   1. Migraine
      Migraine sufferers who have shown any of the following unpredictable sudden onset of an aura with impairment, notably vision, loss of sensation or function of a hand, cause produce severe mood alterations or, in the case of basilar artery migraine, causes vertigo, diplopia or clouding of consciousness or the severe headache accompanied by nausea, vomiting and photophobia may suddenly impair a diver's ability to function safely underwater and should be disqualified for diving.
      
      
   2. Head Injuries
      The main considerations on return to diving after head trauma are residual neurologic deficit which would interfere with performance and the risk of post-traumatic seizures. A history of intracranial haemorrhage, brain contusion, seizures which occur soon after the injury, or prolonged unconsciousness or amnesia all raise the risk of post-traumatic seizure disorders.
      
      With penetration of the dura, seizures are expected to occur in 30 - 50% of cases. Both should be carefully assessed by neurologist before return to dive.
      
      
   3. Seizure Disorders
      Major or minor seizure disorders are absolutely disqualifying for diving, regardless of control by anticonvulsant medication. The attack may be preceded by a warning or aura which is usually momentary and may be a motor, sensory or emotional change, indicating the part of the brain where the discharges start. The typical periodic breathholding during the tonic and clonic phases of a major seizure make rescue, bringing the diver to the surface, an especial risk for pulmonary overpressure accident with resulting pneumothorax or arterial gas embolism.
      
      A history of episodes of unconsciousness early in life should evoke evaluation. The neurological evaluation at the time of the episodes may have included EEG, but normal EEG would not overrule a good clinical impression that the attack was due to epilepsy. A history of epileptiform seizures in childhood is disqualifying for diving unless there is good evidence they were simple febrile seizures.
      
      
   4. Spine Injury
      A history of spinal cord trauma with neurologic deficit should be cause for disqualification, with or without residual deficit. A history of Guillain-Barre Syndrome, Brown-Sequard Syndrome, degenerative joint disease as seen with spinal stenosis and cervical disc disease with peripheral sign are all considered disqualifying.
      
      
   5. History Of Cerebrovascular Accident
      A history of cerebrovascular accident should be cause for disqualification. Even though function has apparently been restored, the likelihood of loss of neural reserve and possible local CNS hypoperfusion make serious CNS decompression sickness more likely. History of transient ischemic attack is also disqualifying.
      
      
   6. Trigeminal Neuralgia
      Patients with a trigger zone in the face mask contact area could suffer attacks during diving or donning diving gear.
      
      
   7. Peripheral Neuropathy
      Patients with peripheral neuropathy deserve individual evaluation regarding underlying disorders and functional disability which could interfere with diving activities. In general, disqualification must be advised because of inability to differentiate neuropathy from decompression sickness in diving.
      

The above information provided by Dr Ronson C.T. LI