Immersion Pulmonary Edema: A Diver’s Guide to Breathing Easy (or Not!)
Have you ever experienced unexpected breathlessness while diving? It might be more than just nerves or a poorly adjusted regulator. Dr. Vera Wittenberg sheds light on a potentially serious condition called Immersion Pulmonary Edema (IPE).
What is Immersion Pulmonary Edema?
Immersion Pulmonary Edema (IPE) is a condition where fluid accumulates in the lungs during a dive. The underwater environment creates unique circulatory and respiratory challenges, which can lead to this dangerous state, even in otherwise healthy individuals. It’s like a cruel trick of the sea, mimicking the symptoms of serious heart conditions in those who might be perfectly fit on land.
The Culprits Behind IPE: A Perfect Storm of Factors
IPE isn’t caused by a single factor, but rather a combination of several, including:
- Immersion: Simply being submerged in water causes significant shifts in blood volume. Water pressure acts like a full-body compression stocking, squeezing blood from the extremities back toward the heart. This increases the blood the heart has to manage (preload increase).
- Water Pressure: At the same time, the heart faces increased resistance as it pumps blood out to the body (afterload increase), because the water pressure compresses blood vessels
- Cold: Cold water constricts blood vessels, further increasing the heart’s workload and promoting fluid leakage into the lungs.
- Increased Breathing Effort: Working harder to breathe against the water pressure, especially with a poorly maintained regulator or a tight wetsuit, creates negative pressure in the lungs, which can draw fluid in.
- Pre-existing Conditions: High blood pressure (even when managed with medication) and underlying heart conditions significantly increase the risk.
- Overexertion: Strenuous swimming or fighting currents can push your body over the edge.
- Predisposition: Some individuals may be more susceptible to IPE.
Recognizing the Warning Signs: Don’t Ignore the Red Flags
Early recognition is crucial. Be alert for these symptoms during or after a dive:
- Coughing
- Unusual Rattling Sounds in the Lungs
- Shortness of Breath
- Fatigue
- Frothy Sputum, Possibly Tinged with Blood
Important Note: During ascent, as oxygen partial pressure decreases, a diver with IPE may experience life-threatening hypoxia and even lose consciousness. This is especially dangerous and can lead to drowning.
What to Do If You Suspect IPE: Safety First
If you or your buddy experience any of these symptoms during a dive:
- Immediately and Safely Ascend: Signal your buddy and begin a controlled ascent.
- Minimize Exertion: Avoid strenuous swimming.
- Monitor Closely: Never leave a diver with suspected IPE alone, especially during ascent.
- Seek Medical Attention: Even if symptoms improve quickly after exiting the water, a medical evaluation is essential. More severe cases require immediate hospitalization. Oxygen should be administered if available.
- Decompression Chamber Treatment is NOT indicated for IPE.
- Rest and Recover: Both the affected diver and their buddy may experience trauma from the event. Allow ample time for rest and recovery.
Prevention is Key: Dive Smart
While IPE can be frightening, you can take steps to minimize your risk:
- Be Physically Fit: Regular exercise improves cardiovascular health and reduces the strain on your heart.
- Control Blood Pressure: Manage hypertension through medication and lifestyle changes.
- Stay Warm: Wear adequate thermal protection to prevent vasoconstriction.
- Maintain Your Equipment: Ensure your regulator is properly serviced and provides adequate airflow.
- Avoid Overexertion: Dive within your limits and avoid strenuous activity.
- Listen to Your Body: Don’t ignore warning signs of overexertion or discomfort.
- Consider a Medical Evaluation: If you have any concerns about your cardiovascular health, consult with a cardiologist before diving.
- Stay Updated: Keep learning about dive safety and medical conditions related to diving.
Diving After IPE: A Difficult Decision
Recovering from IPE requires a thorough evaluation by a diving medicine specialist and possibly a cardiologist. Continuing to dive after experiencing IPE is a personal decision that should be made in consultation with your healthcare providers, carefully weighing the risks and benefits. Ultimately, if your doctor advises against diving, remember: that the best dive is a safe dive. And finally, remember this:
While diving, you should always be prepared. So don’t forget to bring a towel.
You don’t want to get caught in a tide of emotions afterwards!
