Cerebral arterial gas embolism and neurogenic stunned myocardium in a previously healthy freediver

Tyler J Baldino; Mei S Goh

Cerebral arterial gas embolism and neurogenic stunned myocardium in a previously healthy freediver

Undersea Hyperb Med. 2023 Third Quarter;50(3):319-324.

Authors

Tyler J Baldino¹, Mei S Goh²

Affiliations

¹ U.S. Navy Explosive Ordnance Disposal Mobile Unit Five, Santa Rita, Guam.
² U.S. Navy USS Frank Cable (AS-40), Santa Rita, Guam.

PMID: 37708066

Abstract

Cardiomyopathy is a known but rare sequelae of diving-related cerebral arterial gas embolism (CAGE). In previously reported cases, patient findings have been consistent with takotsubo cardiomyopathy (TCM) per the revised Mayo Clinic's diagnostic criteria. A lesser-known variant of stress-related cardiomyopathy is neurogenic stunned myocardium (NSM), which occurs after a neurological event such as subarachnoid hemorrhage and typically presents in younger patients. Presentation tends to differ slightly to TCM with non-specific left ventricular dysfunction and T wave inversions. This case adds to the rare numbers of reported cardiomyopathy from diving and is the first reported case of suspected NSM associated with CAGE.

Keywords: NSTEMI; barotrauma; breath-hold diving; cardiomyopathy; cardiovascular; cerebral arterial gas embolism (CAGE); electrocardiography; hyperbaric oxygen; neurogenic stunned myocardium; pneumomediastinum; snorkeling.