{"id":2151,"date":"2020-07-14T13:44:01","date_gmt":"2020-07-14T17:44:01","guid":{"rendered":"http:\/\/wordpress.world.dan.org\/?post_type=dan_health_resources&#038;p=2151"},"modified":"2020-09-17T11:57:36","modified_gmt":"2020-09-17T15:57:36","slug":"arrhythmias","status":"publish","type":"dan_health_resources","link":"https:\/\/world.dan.org\/fr\/health-medicine\/health-resource\/dive-medical-reference-books\/the-heart-diving\/arrhythmias\/","title":{"rendered":"Chapitre 5 : Arythmies"},"content":{"rendered":"<p class=\"has-medium-font-size\"><em><strong>\u201cBy 2050, it is estimated that atrial fibrillation (AFib) will affect between 5.6 million and 12 million Americans.\u201d<\/strong><\/em><\/p>\n\n\n\n<p>The electrical wiring of your heart \u2014 which controls the rate at which your heart beats, every minute, hour and day, 365 days a year \u2014 is one of the most sophisticated and enduring pieces of nature\u2019s engineering. However, there are some irregularities that can occur in that wiring as well as damage that can be caused by disease, all of which can cause symptoms and increase the risk of premature death. Divers, and any physicians who treat them, should be familiar with arrhythmias and their effects on the safety of scuba divers.<\/p>\n\n\n\n<p>Dans ce chapitre, vous apprendrez ce qui suit :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"#overview\">Aper\u00e7u des arythmies<\/a><\/li><li><a href=\"#syncope\">Syncope<\/a><\/li><li><a href=\"#extrasystole\">Extrasystole<\/a><\/li><li><a href=\"#afib\">Fibrillation auriculaire<\/a><\/li><li><a href=\"#sudden-cardiac-arrest\">Arr\u00eat cardiaque soudain<\/a><\/li><li><a href=\"#pacemakers\">Questions relatives aux stimulateurs cardiaques implant\u00e9s<\/a><\/li><\/ul>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"overview\">Aper\u00e7u des arythmies<\/h2>\n\n\n\n<p>The term \u201carrhythmia\u201d (or, sometimes, \u201cdysrhythmia\u201d) means an abnormal heartbeat. It is used to describe manifestations ranging from benign, harmless conditions to severe, life-threatening disturbances of the heart\u2019s rhythm.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"256\" height=\"156\" src=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/arrhythmia-dysrhythmia-947331372-DAN-256x156-1.jpg\" alt=\"\" class=\"wp-image-11381\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/arrhythmia-dysrhythmia-947331372-DAN-256x156-1.jpg 256w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/arrhythmia-dysrhythmia-947331372-DAN-256x156-1-18x12.jpg 18w\" sizes=\"auto, (max-width: 256px) 100vw, 256px\" \/><\/figure><\/div>\n\n\n\n<p>A normal heart beats between 60 and 100 times a minute. In well-trained athletes, or even select nonathletic individuals, the heart may beat at rest as slowly as 40 to 50 times a minute. Even entirely healthy, normal individuals experience occasional extra beats or minor changes in their heart\u2019s rhythm. These can be caused by drugs (such as caffeine) or stress or can occur for no apparent reason. Arrhythmias become serious only when they are prolonged or when they do not result in proper contraction of the heart.<\/p>\n\n\n\n<p>Physiologically significant extra heartbeats may originate in the upper chambers of the heart (this is called \u201csupraventricular tachycardia\u201d) or in the lower chambers of the heart (this is called \u201cventricular tachycardia\u201d). The cause of these extra beats may be a short circuit or an extra conduction pathway in the heart\u2019s wiring, or it may be the result of some other cardiac disorder. People who have episodes or periods of rapid heartbeat are at risk of losing consciousness during such events. Other people have a fairly stable arrhythmia (such as \u201cfixed atrial fibrillation\u201d) but in conjunction with additional cardiovascular disorders or other health problems that exacerbate the effect of their rhythm disturbance. A too-slow heartbeat (or a heart blockage) may cause symptoms, too.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Effet sur la plong\u00e9e<\/h3>\n\n\n\n<p>Serious arrhythmias, such as ventricular tachycardia and many types of atrial arrhythmia, are incompatible with diving. The risk for any person who develops an arrhythmia during a dive is, of course, losing consciousness while underwater. Supraventricular tachycardia, for example, is unpredictable in its onset and may even be triggered simply by immersing one\u2019s face in cold water. Anyone who has had more than one episode of this type of arrhythmia should not dive.<\/p>\n\n\n\n<p>La plupart des arythmies n\u00e9cessitant un traitement m\u00e9dicamenteux interdisent \u00e9galement \u00e0 la personne concern\u00e9e de plonger en toute s\u00e9curit\u00e9. Des exceptions peuvent \u00eatre faites au cas par cas, en consultation avec un cardiologue et un m\u00e9decin de plong\u00e9e.<\/p>\n\n\n\n<p>Toute personne souffrant d'une arythmie cardiaque doit faire l'objet d'une \u00e9valuation m\u00e9dicale compl\u00e8te par un cardiologue avant de pratiquer la plong\u00e9e. Dans certains cas, des \u00e9tudes \u00e9lectrophysiologiques peuvent identifier une voie de conduction anormale et le probl\u00e8me peut \u00eatre corrig\u00e9. R\u00e9cemment, les cliniciens et les chercheurs ont d\u00e9termin\u00e9 que les personnes souffrant de certaines arythmies (comme certains types de syndrome de Wolff-Parkinson-White, qui se caract\u00e9rise par une voie de conduction \u00e9lectrique suppl\u00e9mentaire) peuvent pratiquer la plong\u00e9e en toute s\u00e9curit\u00e9 apr\u00e8s une \u00e9valuation compl\u00e8te par un cardiologue. De m\u00eame, dans certains cas, les personnes souffrant d'arythmie auriculaire stable (comme la fibrillation auriculaire non compliqu\u00e9e) peuvent plonger en toute s\u00e9curit\u00e9 si un cardiologue d\u00e9termine qu'elles n'ont pas d'autres probl\u00e8mes de sant\u00e9 importants.<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"syncope\">Syncope<\/h2>\n\n\n\n<p>La syncope est une perte de conscience brutale suivie d'une r\u00e9cup\u00e9ration relativement rapide. Les causes de la syncope peuvent \u00eatre relativement b\u00e9nignes ou mettre la vie en danger. Elle est rarement n\u00e9glig\u00e9e et pr\u00e9cipite g\u00e9n\u00e9ralement la consultation d'un professionnel de la sant\u00e9.<\/p>\n\n\n\n<p>Les syncopes qui se produisent dans ou autour de l'eau posent des probl\u00e8mes particuliers. La noyade survient souvent lorsqu'un plongeur perd connaissance et reste dans l'eau. Une r\u00e9ponse rapide est n\u00e9cessaire pour ramener un plongeur inconscient \u00e0 la surface et \u00e9viter qu'il ne meure. La syncope peut \u00e9galement survenir \u00e0 la sortie de l'eau, en raison de facteurs tels que l'effort, la d\u00e9shydratation et le retour normal du volume sanguin dans les extr\u00e9mit\u00e9s inf\u00e9rieures.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignleft size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"256\" height=\"195\" src=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/syncope_136006655-DAN-256x195-1.jpg\" alt=\"\" class=\"wp-image-11400\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/syncope_136006655-DAN-256x195-1.jpg 256w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/syncope_136006655-DAN-256x195-1-16x12.jpg 16w\" sizes=\"auto, (max-width: 256px) 100vw, 256px\" \/><\/figure><\/div>\n\n\n\n<p>La r\u00e9ponse initiale \u00e0 une syncope doit se concentrer sur l'ABC de la r\u00e9animation de base : voies respiratoires, respiration et circulation. Une assistance cardiaque avanc\u00e9e peut s'av\u00e9rer n\u00e9cessaire. Souvent, le fait de placer les patients syncopaux sur le dos dans un environnement frais leur permet de reprendre rapidement conscience. Si une syncope survient apr\u00e8s une plong\u00e9e, il est important d'envisager la maladie de d\u00e9compression, la surinflation pulmonaire et l'\u0153d\u00e8me pulmonaire d'immersion en plus des causes habituelles de l'affection. Bien que la syncope et l'arr\u00eat cardiaque entra\u00eenent tous deux une perte de conscience, il est g\u00e9n\u00e9ralement possible de les diff\u00e9rencier clairement.<\/p>\n\n\n\n<p>The list of possible causes of syncope is extensive, but a good medical history can help eliminate the majority of them. The patient\u2019s age, heart rate, family history, medical conditions and medications are key in identifying the cause. If syncope is accompanied by convulsions (known as \u201ctonic-clonic movements\u201d), it may have been precipitated by a seizure. If it occurs upon exertion, a serious cardiac condition may be preventing the heart from keeping up with the demands of the physical activity; chest pain may be associated with this type of syncope. If standing up quickly results in syncope, that points to a cause known as \u201corthostatic hypotension.\u201d And pain, fear, urination, defecation, eating, coughing or swallowing may cause a variation of the condition known as \u201creflex syncope.\u201d<\/p>\n\n\n\n<p>A medical evaluation after an incident of syncope should include a thorough history and physical \u2014 plus interviews with witnesses who observed the individual\u2019s collapse and who can accurately relay the sequence of events. A few cases may require more extensive investigation, and some result in no conclusion.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Effet sur la plong\u00e9e<\/h3>\n\n\n\n<p>While a medical evaluation is being conducted, it is recommended that the affected individual refrain from any further diving. The cause of a given syncopal episode can be elusive but must be pursued \u2014 especially if the individual hopes to return to diving. Once the underlying factors have been determined, a diving medical officer and appropriate specialists should consider whether diving can be resumed safely.<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"extrasystole\">Extrasystole<\/h2>\n\n\n\n<p>Heart beats that occur outside the heart\u2019s regular rhythm are known as \u201cextrasystoles.\u201d They often arise in the ventricles, in which case they are referred to as \u201cpremature ventricular contractions\u201d or sometimes \u201cpremature ventricular complexes,\u201d abbreviated as PVCs. The cause of such extra beats can be benign or can result from serious underlying heart disease.<\/p>\n\n\n\n<p>Les PVC sont fr\u00e9quents m\u00eame chez les personnes en bonne sant\u00e9 ; ils ont \u00e9t\u00e9 enregistr\u00e9s chez 75 % des personnes soumises \u00e0 une surveillance cardiaque prolong\u00e9e (c'est-\u00e0-dire pendant au moins 24 heures). L'incidence des PVC augmente \u00e9galement avec l'\u00e2ge ; elles ont \u00e9t\u00e9 enregistr\u00e9es chez plus de 5 % des personnes \u00e2g\u00e9es de plus de 40 ans qui subissent un \u00e9lectrocardiogramme (ou ECG, un examen qui prend g\u00e9n\u00e9ralement moins de 10 minutes). Les hommes semblent plus touch\u00e9s que les femmes.<\/p>\n\n\n\n<p>The extrasystole itself is usually not felt. It is followed by a pause \u2014 a skipped beat \u2014 as the heart\u2019s electrical system resets itself. The contraction following the pause is usually more forceful than normal, and this beat is frequently perceived as a palpitation \u2014 an unusually rapid or intense beat. If extrasystoles are either sustained or combined with other rhythm abnormalities, affected individuals may also experience dizziness or lightheadedness. Heart palpitations and the sensation of missed or skipped beats are the most common complaints of those who seek medical care for extrasystole.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"256\" height=\"174\" src=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/extrasystole-ekg-stethescope-97621181-DAN-256x174-1.jpg\" alt=\"\" class=\"wp-image-11401\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/extrasystole-ekg-stethescope-97621181-DAN-256x174-1.jpg 256w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/extrasystole-ekg-stethescope-97621181-DAN-256x174-1-18x12.jpg 18w\" sizes=\"auto, (max-width: 256px) 100vw, 256px\" \/><\/figure><\/div>\n\n\n\n<p>A medical examination of the condition begins with a history and physical and should also include an ECG and various laboratory tests, including the levels of electrolytes (such as sodium, potassium and chloride) in the blood. In some cases, doctors may recommend an echocardiogram (an ultrasound examination of the heart), a stress test and\/or the use of a Holter monitor (a device that records the heart\u2019s electrical activity continuously for a 24- to 48-hour period). Holter monitoring may uncover PVCs that are unifocal \u2014 that is, they originate from a single location. Of greater concern are multifocal PVCs \u2014 those that arise from multiple locations \u2014 as well as those that exhibit specific patterns known R-on-T phenomenon, bigeminy and trigeminy.<\/p>\n\n\n\n<p>If serious structural disorders, such as coronary artery disease or cardiomyopathy (a weakening of the heart muscle), can be ruled out \u2014 and the patient remains asymptomatic \u2014 the only \u201ctreatment\u201d required may be reassurance. But for symptomatic patients, the course is less clear, as there is controversy regarding the effectiveness of the available treatment options. Two drugs commonly used to treat high blood pressure \u2014 beta blockers and calcium channel blockers \u2014 have been used in patients with extrasystole with some success. Antiarrhythmics have also been prescribed for extrasystole but have met with mixed reviews. A procedure known as cardiac ablation may be an option for symptomatic patients, if the location where their extra beats arise can be identified; the procedure involves threading tiny electrodes into the heart via catheters, then zapping the affected locations to rewire the heart\u2019s faulty circuits.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Effet sur la plong\u00e9e<\/h3>\n\n\n\n<p>Bien que les PVC soient pr\u00e9sents chez un grand pourcentage d'individus par ailleurs normaux, il a \u00e9t\u00e9 d\u00e9montr\u00e9 qu'ils augmentent la mortalit\u00e9 au fil du temps. Si des PVC sont d\u00e9tect\u00e9es, il est important de les examiner et d'exclure les pathologies associ\u00e9es connues. Les plongeurs qui souffrent de PVC et dont on d\u00e9couvre qu'ils sont \u00e9galement atteints d'une maladie coronarienne ou d'une cardiomyopathie s'exposent \u00e0 un risque important s'ils continuent \u00e0 plonger. Les plongeurs chez qui l'on a diagnostiqu\u00e9 un ph\u00e9nom\u00e8ne R-on-T, des \u00e9pisodes non soutenus de tachycardie ventriculaire ou des PVC multifocales doivent \u00e9galement s'abstenir de plonger. Les plongeurs qui pr\u00e9sentent des PVC mais qui restent asymptomatiques peuvent envisager de reprendre la plong\u00e9e ; ces personnes doivent discuter avec leur cardiologue de leurs r\u00e9sultats m\u00e9dicaux, de leur d\u00e9sir de continuer \u00e0 plonger et de leur bonne compr\u00e9hension des risques encourus.<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"afib\">Fibrillation auriculaire<\/h2>\n\n\n\n<p>Atrial fibrillation (AF or AFib), the most common form of arrhythmia, is characterized by a fast and irregular heartbeat. It results from a disturbance of the electrical signals that normally make the heart contract in a controlled rhythm. Instead, chaotic and rapid impulses cause uncoordinated atrial filling and ventricle pumping action. This leads to a decrease in overall cardiac output, which can affect one\u2019s exercise capacity or even result in unconsciousness. In addition, AF causes blood to pool in the atria, which promotes the formation of blood clots that may break loose and enter the circulatory system; if this occurs, it may result in a stroke.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"500\" src=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/normal-vs-atrial-fibrillation-89144218-DAN-800x500-1.jpg\" alt=\"\" class=\"wp-image-11402\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/normal-vs-atrial-fibrillation-89144218-DAN-800x500-1.jpg 800w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/normal-vs-atrial-fibrillation-89144218-DAN-800x500-1-360x225.jpg 360w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/normal-vs-atrial-fibrillation-89144218-DAN-800x500-1-768x480.jpg 768w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/normal-vs-atrial-fibrillation-89144218-DAN-800x500-1-18x12.jpg 18w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><\/figure><\/div>\n\n\n\n<p>Des \u00e9tudes am\u00e9ricaines r\u00e9centes ont montr\u00e9 une augmentation de l'incidence globale de la FA ainsi que des diff\u00e9rences raciales significatives dans sa pr\u00e9valence. Le risque de FA au cours de la vie (\u00e0 l'\u00e2ge de 80 ans) a r\u00e9cemment \u00e9t\u00e9 \u00e9valu\u00e9 \u00e0 21 % chez les hommes blancs et \u00e0 17 % chez les femmes blanches, mais \u00e0 seulement 11 % chez les Afro-Am\u00e9ricains des deux sexes. D'ici 2050, on estime que la FA touchera entre 5,6 et 12 millions d'Am\u00e9ricains. Ces chiffres sont significatifs, car la FA est associ\u00e9e \u00e0 un risque quatre \u00e0 cinq fois plus \u00e9lev\u00e9 d'accident vasculaire c\u00e9r\u00e9bral isch\u00e9mique. Apr\u00e8s ajustement des autres facteurs de risque, les personnes souffrant de FA ont \u00e9galement un risque de d\u00e9mence deux fois plus \u00e9lev\u00e9.<\/p>\n\n\n\n<p>The most common causes of AF are hypertension and coronary artery disease. Additional causes include a history of valvular disorders, hypertrophic cardiomyopathy (a thickening of the heart\u2019s muscle), deep vein thrombosis (DVT), pulmonary embolism, obesity, hyperthyroidism (also called \u201coveractive thyroid\u201d), heavy alcohol consumption, an imbalance of electrolytes in the blood, cardiac surgery and heart failure.<\/p>\n\n\n\n<p>Some people with AF experience no symptoms and are unaware they have the condition until it\u2019s discovered during a physical examination. Others may experience symptoms such as the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Palpitations (battements de c\u0153ur rapides, inconfortables et irr\u00e9guliers ou sensation de basculement dans la poitrine)<\/li><li>Faiblesse<\/li><li>Diminution de la capacit\u00e9 \u00e0 faire de l'exercice<\/li><li>Fatigue<\/li><li>\u00c9tourdissements<\/li><li>Vertiges<\/li><li>Confusion<\/li><li>Essoufflement;<\/li><li>Douleur thoracique<\/li><\/ul>\n\n\n\n<p>L'apparition et la dur\u00e9e de la fibrillation auriculaire s'inscrivent g\u00e9n\u00e9ralement dans l'un des trois sch\u00e9mas suivants :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Occasional (or \u201cparoxysmal\u201d):<\/strong>&nbsp;Le trouble du rythme et ses sympt\u00f4mes vont et viennent, durant quelques minutes \u00e0 quelques heures, puis s'arr\u00eatent d'eux-m\u00eames. Ces \u00e9v\u00e9nements peuvent se produire quelques fois par an et leur fr\u00e9quence augmente g\u00e9n\u00e9ralement avec le temps.<\/li><li><strong>Persistant :<\/strong>&nbsp;The heart\u2019s rhythm doesn\u2019t go back to normal on its own, and treatment \u2014 such as an electrical shock or medication \u2014 is required to restore a normal rhythm.<\/li><li><strong>Permanent :<\/strong>&nbsp;The heart\u2019s rhythm can\u2019t be restored to normal. Treatment may be required to control the heart rate, and medication may be prescribed to prevent the formation of blood clots.<\/li><\/ul>\n\n\n\n<p>Tout nouveau cas de FA doit faire l'objet d'une investigation afin d'en d\u00e9terminer la cause. L'examen peut comprendre un examen physique, un \u00e9lectrocardiogramme, une mesure des niveaux d'\u00e9lectrolytes, y compris le magn\u00e9sium, un dosage des hormones thyro\u00efdiennes, un \u00e9chocardiogramme, une num\u00e9ration sanguine compl\u00e8te et\/ou une radiographie du thorax.<\/p>\n\n\n\n<p>Treating the underlying cause of AF can help control the fibrillation. Various medications, including beta blockers, may help regulate the heart rate. A procedure known as cardioversion \u2014 which can be performed with either a mild electrical shock or medication \u2014 may prompt the heart to revert to a normal rhythm; before cardioversion is attempted, it is essential to ensure that a clot has not formed in the atrium. Cardiac ablation, which is described in the \u201c<a href=\"#extrasystole\">Extrasystole<\/a>\u201d section, may also be used to treat AF. In addition, anticoagulant drugs are often prescribed for individuals with AF to prevent the formation clots and thus reduce their risk of stroke. It is also of note that the neurological effects of an embolic stroke associated with AF can sometimes be confused with the symptoms of decompression sickness.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Effet sur la plong\u00e9e<\/h3>\n\n\n\n<p>A thorough medical examination should be conducted to identify the underlying cause of the atrial fibrillation. It is often the underlying cause that is of most concern regarding fitness to dive. But even atrial fibrillation itself can have a significant impact on cardiac output and therefore on maximum exercise capacity. Individuals who experience recurrent episodes of symptomatic AF should refrain from further diving. The medications often used to control atrial fibrillation can present their own problems, by causing other arrhythmias and\/or impairing the individual\u2019s exercise capacity. It is essential that anyone diagnosed with AF have a detailed discussion with a cardiologist before resuming diving.<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"sudden-cardiac-arrest\">Arr\u00eat cardiaque soudain<\/h2>\n\n\n\n<p>Sudden cardiac arrest (SCA) \u2014 a cessation of the heart\u2019s beating action, with little or no warning \u2014 is an acute medical emergency. During the arrest, blood stops circulating to the body\u2019s vital organs, including the brain, the kidneys and the heart itself. Cut off from oxygen, these organs die within minutes. If the arrest is not corrected quickly, the affected individual will not survive.<\/p>\n\n\n\n<p>The causes of SCA include myocardial infarction (heart attack), heart failure, drowning, coronary artery disease, electrolyte abnormalities, drugs, abnormalities in the heart\u2019s electrical conduction system, cardiomyopathy (a weakening of the heart muscle) and embolism (a clot that has lodged in a major vessel).<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignleft size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"256\" height=\"171\" src=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/cardiac-arrest-CPR-78856453-DAN-256x171-1.jpg\" alt=\"\" class=\"wp-image-11413\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/cardiac-arrest-CPR-78856453-DAN-256x171-1.jpg 256w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/cardiac-arrest-CPR-78856453-DAN-256x171-1-18x12.jpg 18w\" sizes=\"auto, (max-width: 256px) 100vw, 256px\" \/><\/figure><\/div>\n\n\n\n<p>L'ACS est responsable de 450 000 d\u00e9c\u00e8s aux \u00c9tats-Unis chaque ann\u00e9e et de 63 % des d\u00e9c\u00e8s cardiaques chez les Am\u00e9ricains de plus de 35 ans. Le risque de mort subite d'origine cardiaque chez l'adulte est multipli\u00e9 par six avec l'\u00e2ge, parall\u00e8lement \u00e0 l'augmentation de l'incidence des cardiopathies isch\u00e9miques. Le risque d'ACS est plus \u00e9lev\u00e9 chez les personnes souffrant de maladies cardiaques structurelles, mais dans 50 % des cas de mort subite d'origine cardiaque, la victime n'avait pas conscience d'\u00eatre atteinte d'une maladie cardiaque, et dans 20 % des autopsies r\u00e9alis\u00e9es \u00e0 la suite de ces d\u00e9c\u00e8s, aucune anomalie cardiovasculaire structurelle n'a \u00e9t\u00e9 trouv\u00e9e.<\/p>\n\n\n\n<p>Bien qu'il n'y ait g\u00e9n\u00e9ralement pas de signes avant-coureurs d'un arr\u00eat cardiaque soudain, la personne peut parfois ressentir des \u00e9tourdissements, des difficult\u00e9s respiratoires, des palpitations ou des douleurs thoraciques.<\/p>\n\n\n\n<p>Le traitement imm\u00e9diat doit \u00eatre ax\u00e9 sur le r\u00e9tablissement rapide de la circulation \u00e0 l'aide de compressions thoraciques ou d'une r\u00e9animation cardio-pulmonaire et d'une d\u00e9fibrillation. Apr\u00e8s la r\u00e9animation, la victime doit \u00eatre transport\u00e9e \u00e0 l'h\u00f4pital d\u00e8s que possible. Le traitement ult\u00e9rieur peut consister en des efforts pour \u00e9liminer la cause sous-jacente de l'arr\u00eat par l'administration de m\u00e9dicaments, la chirurgie ou l'utilisation de dispositifs \u00e9lectriques implant\u00e9s.<\/p>\n\n\n\n<p>Les strat\u00e9gies pr\u00e9ventives consistent \u00e0 apprendre \u00e0 reconna\u00eetre les signes avant-coureurs de l'ACS, au cas o\u00f9 ils se produiraient ; \u00e0 identifier, \u00e9liminer ou contr\u00f4ler tout facteur de risque susceptible de vous affecter ; et \u00e0 programmer des examens physiques r\u00e9guliers, ainsi que les tests appropri\u00e9s, lorsqu'ils sont indiqu\u00e9s.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Effet sur la plong\u00e9e<\/h3>\n\n\n\n<p>Les plongeurs pr\u00e9sentant des sympt\u00f4mes de maladie cardiovasculaire doivent \u00eatre \u00e9valu\u00e9s par un cardiologue et un sp\u00e9cialiste de la m\u00e9decine de plong\u00e9e quant \u00e0 la poursuite de leur activit\u00e9. Chez les personnes asymptomatiques, le risque de MSC peut \u00eatre \u00e9valu\u00e9 \u00e0 l'aide des facteurs de risque cardiovasculaire connus tels que le tabagisme, l'hypertension art\u00e9rielle, l'hypercholest\u00e9rol\u00e9mie, le diab\u00e8te, le manque d'exercice et le surpoids. Par exemple, les fumeurs ont deux fois et demie plus de risques de souffrir d'une mort cardiaque subite que les non-fumeurs.<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"pacemakers\">Questions relatives aux stimulateurs cardiaques implant\u00e9s<\/h2>\n\n\n\n<p>A pacemaker is a small battery-operated device that helps an individual\u2019s heart beat in a regular rhythm. It does this by generating a slight electrical current that stimulates the heart to beat. The device is implanted under the skin of the chest, just below the collarbone, and is hooked up to heart with tiny wires that are threaded into the organ through its major vessels. In some individuals, the heart may need only intermittent help from the pacemaker, if the pause between two beats becomes too long. In others, however, the heart may depend completely on the pacemaker for regular stimulation of its beating action.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"256\" height=\"256\" src=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/diving-issues-implanted-pacemakers-000004250928-DAN-256x256-1.jpg\" alt=\"\" class=\"wp-image-11426\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/diving-issues-implanted-pacemakers-000004250928-DAN-256x256-1.jpg 256w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/diving-issues-implanted-pacemakers-000004250928-DAN-256x256-1-150x150.jpg 150w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/diving-issues-implanted-pacemakers-000004250928-DAN-256x256-1-12x12.jpg 12w\" sizes=\"auto, (max-width: 256px) 100vw, 256px\" \/><figcaption>thorax avec stimulateur cardiaque sur les radiographies<\/figcaption><\/figure><\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Effet sur la plong\u00e9e<\/h3>\n\n\n\n<p>Chaque cas de stimulateur cardiaque doit \u00eatre \u00e9valu\u00e9 individuellement. Les deux facteurs les plus importants \u00e0 prendre en compte sont les suivants :<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>Pourquoi la personne est-elle d\u00e9pendante d'un stimulateur cardiaque ?<\/li><li>Is the individual\u2019s pacemaker rated to perform at depths (in other words, pressures) compatible with recreational diving \u2014 plus an added margin of safety?<\/li><\/ol>\n\n\n\n<p>La raison de ce deuxi\u00e8me facteur est qu'un stimulateur cardiaque est implant\u00e9 dans des tissus situ\u00e9s juste sous la peau et qu'il est donc expos\u00e9, pendant la plong\u00e9e, aux m\u00eames pressions ambiantes que le plongeur. Pour une plong\u00e9e en toute s\u00e9curit\u00e9, un stimulateur cardiaque doit \u00eatre con\u00e7u pour fonctionner \u00e0 une profondeur d'au moins 40 m\u00e8tres et doit \u00e9galement fonctionner de mani\u00e8re satisfaisante dans des conditions de changements de pression relativement rapides, comme c'est le cas lors de la remont\u00e9e et de la descente.<\/p>\n\n\n\n<p>As with any medication or medical device, the underlying problem that led to the implantation of the pacemaker is the most significant factor in determining someone\u2019s fitness to dive. The need to have a pacemaker implanted usually indicates a serious disturbance in the heart\u2019s own conduction system.<\/p>\n\n\n\n<p>Si la perturbation provient d'une l\u00e9sion structurelle du muscle cardiaque lui-m\u00eame, comme c'est souvent le cas lorsqu'une personne est victime d'une crise cardiaque majeure, il se peut que la personne n'ait pas la capacit\u00e9 cardiovasculaire n\u00e9cessaire pour plonger en toute s\u00e9curit\u00e9.<\/p>\n\n\n\n<p>Toutefois, certaines personnes d\u00e9pendent d'un stimulateur cardiaque non pas parce que le muscle cardiaque a \u00e9t\u00e9 endommag\u00e9, mais simplement parce que la zone qui g\u00e9n\u00e8re les impulsions qui font se contracter le muscle cardiaque ne fonctionne pas de mani\u00e8re coh\u00e9rente ou ad\u00e9quate. Ou bien le circuit qui conduit les impulsions au muscle cardiaque peut \u00eatre d\u00e9fectueux, ce qui se traduit par des signaux incorrects ou irr\u00e9guliers. Sans l'assistance d'un stimulateur cardiaque, ces personnes peuvent souffrir d'\u00e9pisodes de syncope (\u00e9vanouissement). D'autres personnes peuvent avoir subi une crise cardiaque suffisamment l\u00e9g\u00e8re pour que les dommages r\u00e9siduels au muscle cardiaque soient minimes, mais leur syst\u00e8me de conduction reste peu fiable et a donc besoin d'\u00eatre stimul\u00e9 par un stimulateur cardiaque.<\/p>\n\n\n\n<p>If a cardiologist determines that an individual\u2019s level of cardiovascular fitness is sufficient for safe diving, and the individual\u2019s pacemaker is rated to function at a pressure of at least 130 feet (40 meters), that individual may be considered fit for recreational diving. But once again, it cannot be emphasized strongly enough that any divers with cardiac issues check with their doctor before diving.<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-text-align-right\"><strong>Suivant : <a href=\"https:\/\/world.dan.org\/fr\/health-medicine\/health-resource\/dive-medical-reference-books\/the-heart-diving\/pulmonary-and-venous-disorders\/\">Chapter 6 \u2013 Pulmonary and Venous Disorders &gt;<\/a><\/strong><\/p>","protected":false},"excerpt":{"rendered":"<p>&#8220;By 2050, it is estimated that atrial fibrillation (AFib) will affect between 5.6 million and 12 million Americans.&#8221; The electrical wiring of your heart \u2014 which controls the rate at [&hellip;]<\/p>\n","protected":false},"featured_media":11419,"parent":2110,"menu_order":26,"template":"","dan_health_resource_types":[405],"class_list":["post-2151","dan_health_resources","type-dan_health_resources","status-publish","has-post-thumbnail","hentry","dan_health_resource_types-dive-medical-reference-books"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.0 (Yoast SEO v27.3) - 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