Abstract
Cardiac response to breath-hold diving in human beings is primarily characterized by the reduction of both heart rate and stroke volume. By underwater Doppler-echocardiography we observed a “restrictive/constrictive” left ventricular filling pattern compatible with the idea of chest squeeze and heart compression during diving. We hypothesized that underwater re-expansion of the chest would release heart constriction and normalize cardiac function. To this aim, 10 healthy male subjects (age 34.2 ± 10.4) were evaluated by Doppler-echocardiography during breath-hold immersion at a depth of 10 m, before and after a single maximal inspiration from a SCUBA device. During the same session, all subjects were also studied at surface (full-body immersion) and at 5-m depth in order to better characterize the relationship of echo-Doppler pattern with depth. In comparison to surface immersion, 5-m deep diving was sufficient to reduce cardiac output (P = 0.042) and increase transmitral E-peak velocity (P < 0.001). These changes remained unaltered at a 10-m depth. Chest expansion at 10 m decreased left ventricular end-systolic volume (P = 0.024) and increased left ventricular stroke volume (P = 0.024). In addition, it decreased transmitral E-peak velocity (P = 0.012) and increased deceleration time of E-peak (P = 0.021). In conclusion the diving response, already evident during shallow diving (5 m) did not progress during deeper dives (10 m). The rapid improvement in systolic and diastolic function observed after lung volume expansion is congruous with the idea of a constrictive effect on the heart exerted by chest squeeze.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Andersson JPA, Linér MH, Fredsted A, Schagatay EKA (2004) Cardiovascular and respiratory responses to apneas with and without face immersion in exercising humans. J Appl Physiol 96:1005–1010. doi:10.1152/japplphysiol.01057.2002
Arborelius M, Balldin UI, Lidja B, Lundgren CEG (1972) Hemodynamic changes in man during immersion with the head above water. Aerosp Med 43:592–598
Arques S, Roux E, Luccioni R (2007) Current clinical applications of spectral tissue Doppler echocardiography (E/E′ ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved systolic function. Cardiovasc Ultrasound 5:16. doi:10.1186/1476-7120-5-16
Bedini R, Reale A, Belardinelli A, Passera M, Guerriero L, Navari A, Dalle Luche A, Benassi A, Giuffré E, Cialoni D, Pingitore A, Marabotti C, Data PG (2005) Technologies for underwater biotelemetry during diving. In: Bedini R, Belardinelli A, Reale L (eds) Blue 2005 human behaviour and limits in underwater environment. Special conference on breath-hold diving. STAR CNR Research Campus, Pisa, Italy, p 61
Brick I (1966) Circulatory responses to immersing the face in water. J Appl Physiol 21:33–36
Dahlback GO, Jonsson E, Liner MH (1978) Influence of hydrostatic compression of the chest and intrathoracic blood pooling on static lung mechanics during head-out immersion. Undersea Biomed Res 5:71–85
De Boeck BW, Cramer M-JM, Oh JK, van der Aa RPLM, Jaarsma W (2003) Spectral pulsed tissue Doppler imaging in diastole: a tool to increase our insight in and assessment of diastolic relaxation of the left ventricle. Am Heart J 146:411–419. doi:10.1016/S0002-8703(03)00322-3
Duprez D, De Buyzere M, Trouerbach J, Ranschaert W, Clement DL (2000) Continuous monitoring of haemodynamic parameters in humans during the early phase of simulated diving with and without breathholding. Eur J Appl Physiol 81:411–417. doi:10.1007/s004210050062
Ferrigno M, Hickey DD, Liner MH, Lundgren CEG (1987) Simulated breath-hold diving to 20 meters: cardiac performance in humans. J Appl Physiol 62:2160–2167
Fitz-Clarke JR (2006) Adverse events in competitive breath-hold diving. Undersea Hyperb Med 33(1):55–62
Folland ED, Parisi AF, Moynihan PF, Ray Jones D, Feldman CL, Tow DE (1979) Assessment of left ventricular ejection fraction and volumes by real-time, two-dimensional echocardiography. A comparison of cineangiographic and radionuclide techniques. Circulation 60:760–766
Ha JW, Oh JK, Ling LH, Nishimura RA, Seward JB, Jamil Tajik A (2001) Annulus paradoxus. Transmitral flow velocity to mitral annular velocity ratio is inversely proportional to pulmonary capillary wedge pressure in patients with constrictive pericarditis. Circulation 104:976–978. doi:10.1161/hc3401.095705
Hong SK, Cerretelli P, Cruz JC, Rahn H (1969) Mechanics of respiration during submersion in water. J Appl Physiol 27:535–538
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, St John Sutton M, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463. doi:10.1016/j.echo.2005.10.005
Lindholm P, Ekborn A, Oberg D, Gennser M (2008) Pulmonary edema and haemoptysis after breath-hold diving at residual volume. J Appl Physiol 104:912–917. doi:10.1152/japplphysiol.01127.2007
Marabotti C, Belardinelli A, L’Abbate A, Scalzini A, Chiesa F, Cialoni D, Passera M, Bedini R (2008) Cardiac function during breath-hold diving in humans. An Echocardiographic study. Undersea Hyperb Med 35(2):83–90
Marabotti C, Scalzini A, Cialoni D, Passera M, L’Abbate A, Bedini R (2009) Cardiac changes induced by immersion and breath-hold diving in humans. J Appl Physiol 106:293–297. doi:10.1152/japplphysiol.00126.2008
Nishimura RA, Tajik AJ (1997) Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta stone. J Am Coll Cardiol 30:8–18. doi:10.1016/S0735-1097(97)00144-7
Oh JK, Hatle L, Jamil Tajik A, Little WC (2006) Diastolic heart failure can be diagnosed by comprehensive two-dimensional and Doppler Echocardiography. J Am Coll Cardiol 47:500–506. doi:10.1016/j.jacc.2005.09.032
Pelà G, Regolisti G, Coghi P, Cabassi A, Basile A, Cavatorta A, Manca C, Borghetti A (2004) Effects of the reduction on preload on left and right ventricular myocardial velocities analyzed by Doppler tissue echocardiography in healthy subjects. Eur J Echocardiogr 5:262–271. doi:10.1016/j.euje.2003.10.001
Shiraki K, Konda N, Sagawa S, Lin YC, Hong SK (1986) Cardiac output by impedance cardiography during head-out water immersion. Undersea Biomed Res 13:247–256
Thorsen HC, Zubieta-Calleja G, Paulev PE (2007) Decompression sickness following seawater hunting using underwater scooters. Res Sports Med 15(3):225–239. doi:10.1080/15438620701526852
Acknowledgments
The present study was supported by the CNR Institute of Clinical Physiology, Pisa and by the Master of Underwater and Hyperbaric Medicine of the Scuola Superiore Sant’Anna, Pisa. Authors would also like to acknowledge the DiveSystem company (Follonica—ITALY) for having made available underwater equipments and swimming pool and Ms. Manuella Walker for her valuable support for English revision and editing.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Marabotti, C., Scalzini, A., Cialoni, D. et al. Effects of depth and chest volume on cardiac function during breath-hold diving. Eur J Appl Physiol 106, 683–689 (2009). https://doi.org/10.1007/s00421-009-1068-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00421-009-1068-8