"I thought I'd never dive again"

In the hours following what she thought was a ‘normal’ nine-metre dive, Aithne began to experience what she suspected was decompression sickness – sometimes referred to as ‘the bends’ - for the first time ever, in the form of a sudden skin rash. Decompression sickness happens when dissolved gases (mainly nitrogen) come out of solution in the bloodstream and form gas bubbles in the circulatory system. This can cause fatigue or weakness, dizziness, shortness of breath, chest or abdominal pain, poor coordination or balance and skin rashes or swelling.

Decompression sickness can happen when divers ascend too rapidly from a dive, following long-lasting or multiple dives and in those who set off too quickly from low altitude to high altitude. However, as a regular and experienced diver, Aithne was surprised and confused as to why she was experiencing symptoms for the first time, especially given it was such a shallow, routine dive.

After speaking to some of her fellow divers, Aithne learned that decompression sickness is more prevalent in people with a hole in their heart. She decided to seek advice from Dr Brian Clapp, a Consultant Cardiologist at London Bridge Hospital, part of HCA Healthcare UK. Dr Clapp is considered a leading expert in the diagnosis and treatment of patients with PFOs – and also has a specialist interest in diving, and how it affects the heart.

Aithne was devastated at the thought of being diagnosed with the condition. She recalls: “I think I was in denial about it all at first. I had been diving for years with no problems at all. I could feel the dread building inside of me, thinking that I might be living with a hole in the heart. Diving was such an important part of my life, and I was in total shock at the thought that I might not be able to dive again.

To diagnose Aithne, Dr Clapp carried out an ‘echo bubble study’, where during an ultrasound scan, tiny bubbles are injected into a vein while imaging the heart, to replicate the same process that happens following diving. Dr Clapp measured the number of bubbles that passed from one side to the other of Aithne’s heart – the more bubbles that pass through, the larger the hole. Dr Clapp also scanned Aithne’s lungs to check for any respiratory issues that could have caused or contributed to the decompression sickness, but they were completely healthy.

Dr Clapp diagnosed Aithne with a Grade 4 PFO, which is considered extremely significant. A hole in the heart is more common than you might think, affecting 25% of the adult population. Most people are unaware that they are living with this condition, but for scuba divers in particular, the condition can be life-threatening. The cardiology department were stunned that Aithne had been diving for so long and hadn’t experienced any form of decompression sickness or serious complications to date. 

Dr Clapp says: “When you go diving, it’s important to be aware of your medical history, because the danger with diving is that if something does go wrong, it can go wrong very quickly. There are a number of respiratory issues that can also cause decompression sickness, although if this happens because of an issue with your lungs, the affect will generally be more immediate. It’s important to seek expert medical advice if you’re experiencing any symptoms of decompression sickness.”

After receiving her diagnosis, Dr Clapp advised her that without surgery, while she could try and continue diving very conservatively, including at a maximum depth of 15 metres, this would come with significant risks. However, as this happened to her at a depth of just nine metres and she wanted to dive without restrictions, Aithne knew her best option was to undergo surgery to close the hole in her heart.

In October 2020, Aithne went for her operation. Making a small incision in a blood vessel in Aithne’s leg and using a fine tube under control of both an X-ray camera and ultrasound machine, Dr Clapp placed a small metal device over the hole in her heart. This device acts like a plug and the tissue in the heart then heals over the discs. The procedure is quick and minimally invasive - the day after her surgery she was already up and walking around.

Aithne says: “From the initial consultation to the surgery taking place, it took just six weeks. It could have been even quicker, but I delayed the procedure as I wanted to think about all my options first. It all happened so fast, I didn’t even have a chance to tell some of my friends I had a hole in my heart before it was closed! The surgery itself was so amazing – because of the minimal downtime and discomfort, it really didn’t feel like I’d undergone heart surgery

One month after her surgery, Aithne had a follow up with Dr Clapp, and at six months she underwent another echo bubble study to check if the hole had properly closed. The results were positive; the skin had healed over the implanted device, meaning it was safe for Aithne to go diving again. Aithne booked a dive trip for the following week!

Aithne says: “I only missed out on six months of diving! Some of my friends were very jealous as they had missed longer due to COVID-19 restrictions. I couldn’t have timed it better myself. It just felt so wonderful to be a healthy 27-year-old and get back in the water to see all of the beautiful underwater life. It was just incredible to be able to enjoy the activity I love so much”.