The tragic passing of renowned singer in India, Zubeen Garg, has sparked concerns about the potential risks associated with scuba diving and its impact on cardiovascular health. While the official cause of his death has not been disclosed, some reports have speculated on a possible heart-related incident during a diving activity, prompting a closer examination of this issue.

The body’s response to the underwater world

Scuba diving requires your body to adapt to conditions far removed from everyday life. Several key physiological factors are at play:

• The pressure equation: Descending into the ocean means an increase in ambient pressure. This influences gas diffusion in your lungs and can subtly alter blood flow dynamics, potentially leading to changes in heart rate and blood pressure.
• Cold water immersion: Diving in colder temperatures can trigger the body’s “cold shock response,” characterized by an involuntary gasp, a rapid increase in heart rate, and a rise in blood pressure as blood vessels constrict to conserve core heat. This effect is more pronounced in sudden immersion in very cold water.
• Breathing mechanics and gas exchange: While scuba divers breathe compressed air, the act of exhaling against increasing water pressure and maintaining a controlled breathing pattern is physically demanding. In some circumstances, compromised breathing can lead to lower oxygen levels (hypoxia) or higher carbon dioxide levels (hypercapnia), which may stress the cardiovascular system.
• Physical exertion: Even seemingly placid dives involve exertion. Swimming against currents, maneuvering heavy equipment, or adjusting to buoyancy requires energy, increasing the heart’s workload.

Scientific evidence

While scuba diving is safe for the vast majority of healthy individuals, studies suggest a correlation between diving and cardiac events in those with undiagnosed or pre-existing heart conditions.

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The most significant risk factor identified is undiagnosed Coronary Artery Disease (CAD). Atherosclerosis, the gradual buildup of fatty plaques in the coronary arteries, can narrow or block the pathways that supply blood to the heart muscle. The physiological stresses inherent in diving, increased cardiac demand and altered circulation, can exacerbate compromised blood flow. This can manifest as angina (chest pain) or, in severe cases, a myocardial infarction (heart attack). Research published in cardiology journals has shown that a substantial percentage of divers who experience cardiac emergencies have underlying, often asymptomatic, CAD.

Other contributing factors to cardiac risk in divers can include:

• Arrhythmias: Irregular heart rhythms can be triggered or worsened by the physiological changes associated with diving.
• Heart failure: Individuals with a weakened heart muscle or impaired pumping function may not tolerate the increased demands of diving.
• Hypertension (High Blood Pressure): Poorly controlled high blood pressure increases risk during stressful activities.
• Associated health conditions: Obesity, diabetes, and other risk factors for heart disease can compound potential dangers.

Pre-dive medical screening

The key to safe diving, especially concerning heart health, lies in comprehensive pre-dive screening. Medical professionals, particularly those with expertise in diving medicine, are essential. A thorough evaluation typically includes:

• Personal and family medical history, with a focus on cardiovascular health
• Physical examination
• Assessment of cardiovascular risk factors such as blood pressure, cholesterol levels, and BMI
• Electrocardiogram (ECG) to detect potential heart rhythm abnormalities
• In high-risk cases, additional tests like a cardiac stress test

Based on these assessments, a physician can determine an individual’s fitness to dive, recommend precautions, or advise against diving altogether.

Safe diving practices

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For those cleared to dive, adhering to safety guidelines is paramount:

• Gradual transitions: Maintain slow, controlled ascents and descents to allow your body to adapt to pressure changes.
• Hydration: Proper hydration helps maintain blood volume and reduces the risk of decompression sickness.
• Pacing: Avoid strenuous activity immediately before or after diving.
• Respect your limits: Never push yourself beyond your training or physical capabilities.
• Buddy system: Always dive with a partner who can provide assistance in an emergency.
• Recognize symptoms: If you experience chest pain, shortness of breath, or unusual fatigue, ascend immediately and seek medical attention.

By recognizing the physiological demands of scuba diving, taking preventive measures, and seeking medical guidance, divers can better protect their heart health and enjoy the underwater world safely. As with any physical activity, it is crucial to prioritize cardiovascular well-being and remain vigilant for any signs of distress.