Chest pain accompanied by shortness of breath is not a common complaint in diving medicine, but if it occurs, it usually indicates a very serious illness.
The key points to have a fairly good idea about the cause are
- The nature of the pain.
- The Location of the pain
- Time of onset of pain.
In addition to the history of the dive including depth, dive profile and particular events during the dive.
The most common causes are:
Pulmonary DCS (chokes)
For pulmonary DCS to occur either a large amount of decompression was omitted, or a very long stressful decompression dive was made. (following deep long air dives).
It is reported that more than half of the patients with chokes have other associated forms of DCS (musculoskeletal, spinal or inner ear).
It can happen any time during the ascent and for a few hours after the dive.
The chest pain is substernal (middle of chest) that progressively gets worse and is accompanied by coughing, feeling of distress, dyspnea (shortness of breath) and is worsened by deep inhalation.
It occurs following a dive requiring minimal to moderate decompression and it can occur with a no decompression dive if the diver has an underlying spinal cord injury (disc problems)
The pain starts at the back and gradually takes the form of dull
girdle-like chest pain.
It usually presents shortly after surfacing (A few minutes to one hour) and is followed very shortly with the spinal DCS symptoms such as weakness, numbness or paralysis.
It results from accidental lung over inflation injury when holding breath during ascent, or as a result of obstructed bronchial passages as in cases of asthma, obstructive lung diseases or smoking.
Symptoms occur during or immediately after the ascent.
The pain is more located over the sides of the chest.
The accompanying symptom such as tachypnea (rapid breathing rate) and dyspnea are usually severe.
Deviations of the trachea to one side and absent breath sounds over the affected area are distinctive.
Although uncommon, pneumothorax has to be ruled out before any recompression therapy is made.
It results from a lung over inflation injury, but the air in this case escapes in the chest cavity in the space between the lungs.
Symptoms occur during or shortly after ascent.
The pain is sharp substernal with a tight feeling and radiating to both the shoulders back and neck.
The pain increases by deep breathing, coughing, swallowing and laying flat. Voices change and can be present as well.
In severe cases, Dyspnea as well as a crackling sound can be felt at the base of the neck on both sides.
Myocardial ischemia (inadequate blood supply to the heart muscle)
Very severe substernal pain that spreads to the left side of the chest indicates myocardial ischemia.
It can occur any time during or after the dive.
It is usually caused by coronary artery disease.
A history of angina (chest pain on exertion), or hypertension is usually found.
Anxiety-Hyperventilation (A.H) Syndrome
This condition is common in new divers. The diver complains of dyspnea, substernal tightness, dizziness, numbness of feet, hands, that progresses sometimes to spasm of fingers and toes.
We have to be careful and rule out other causes such as the chokes and pneumomediastinum before diagnosing A.H syndrome.
History of the trauma and pain on pressure of the location of injury is evident.
Another important pain happens due to fatigue of the respiratory muscles during long dives using regulators with high resistance.
Chest pain during, immediately or a few hours after the dive has to betaken seriously and followed up for any progressing symptoms.
Wishing you all safe dives
Dr. Hanaa M. Nessim