An overweight 50-year-old diver suffers an apparent cardiac event while swimming.
I hired someone to teach me underwater photography and take me on my first ocean dive. The instructor asked if I minded if a friend from his dive club — I’ll call him FF —joined us on our dives. I had no problem with that. FF was 50 years old and weighed 280 pounds.
We got geared up and attempted our first dive from the rocky shore without luck. Both FF and I were under weighted. After adding more weight, we tried again. FF descended by pulling himself down the buoy line, but I still was unable to get down. The instructor retrieved FF, and I again added more weight.
This time I was able to descend, and the instructor was behind me. When we reached the bottom, we noticed FF was gone. The instructor resurfaced and found that FF had returned to the shore and was sitting out this dive. Later we found out his rented buoyancy-compensating device (BCD) was not dumping air. He said he fixed the problem by blowing in the manual-inflate hose and dumping the air through a bottom dump valve.
We did our surface interval and had lunch.
For our second dive, we had planned a long surface swim of 197 yards to a sunken ship. FF and I headed for the stairs approximately 10 feet from our gear site; FF became winded, so we rested. We got to the bottom of the stairs, doubled checked each other and entered the water at 12:20 p.m.
On the surface swim, the instructor got a little ahead but kept checking on us. FF yelled out that he needed a break. I got my kit tied up in the kelp, and FF helped me out of it. I had a small area where the kelp was clear, so I rolled over to my back and started a back swim. I caught up to the instructor with ease. I noticed FF was headed for the rocks with kelp tied on his tank.
The instructor asked if I was OK to sit tight while he helped FF. I agreed and just relaxed in the ocean. I remember FF saying something that sounded like, “Ouch.” The instructor untied him and asked if he was OK. FF said he was. The instructor told FF to put on his snorkel and follow him to avoid the kelp. The instructor caught up with me, and we noticed FF was heading out to open water and the kelp again. We tried to get his attention, then I noticed his snorkel went under and his left shoulder rolled forward.
The instructor asked if FF passed out. I replied that something was not right.
I reached FF first, and the instructor arrived less than a second later. I rolled FF over by grabbing his right arm. The instructor removed FF’s mask, and we saw his blue face. I checked for a pulse and could not feel anything. I told the instructor to swim to shore while I started to tow FF. I could see people on the shore, so I screamed for help and the instructor waived his arms. Once we got closer, I yelled for someone to call 911, that he is not breathing, he has no pulse and is blue. A lot of people arrived, and we got FF to the rocks, where we dumped his BCD to get to his chest. I tried a few chest compressions, but not having a stable platform, they were not good ones.
The medical boat entered the park and retrieved FF. He was sent to the chamber on the island, but they did not succeed in resuscitating him.
His dive profile was one dive at 22 feet for no more than 5 to 10 minutes. He never got back under the water, and he never complained about anything other than being out of breath.
In this case, the diver’s death most likely was due to an acute cardiac event. Being overweight is a cardiac risk factor by itself and is often associated with poor physical fitness. With this diver, the lack of fitness was obvious: FF got winded by walking just 10 feet from the gearing site to the stairs. He also needed a break while swimming a short surface distance. Entanglement with kelp added to his exertion. His difficulties with equipment indicate that this person did not dive often and that his skills were not up to the task.
The description of this incident fits sudden cardiac death. The victim had a very low tolerance for exercise, which indicates that he probably had major coronary heart disease. The autopsy will show the true cause of death. Possible mechanisms are many, including a rupture of atherosclerotic plaque or thrombosis caused myocardial infarction to a fatal dysrhythmia due to relative hypoxia of the heart muscle.
There were plenty of warning signs for this diver. He probably had difficulty climbing a few steps of stairs in everyday life, and that is sufficient indication of poor physical fitness. Not only would that exclude one from diving, but it should prompt a person to make changes to improve his health.
Dr. Petar J. Denoble