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Asystole and increased serum myoglobin levels associated with 'packing blackout' in a competitive breath-hold diver.

Andersson, Johan LU ; Linér, Mats LU and Bjursten, Henrik LU (2009) In Clinical Physiology and Functional Imaging2002-01-01+01:00 29(6). p.458-461
Abstract
Summary Many competitive breath-hold divers use 'glossopharyngeal insufflation', also called 'lung packing', to overfill their lungs above normal total lung capacity. This increases intrathoracic pressure, decreases venous return, compromises cardiac pumping, and reduces arterial blood pressure, possibly resulting in a syncope breath-hold divers call 'packing blackout'. We report a case with a breath-hold diver who inadvertently experienced a packing blackout. During the incident, an electrocardiogram (ECG) and blood pressure were recorded, and blood samples for determinations of biomarkers of cardiac muscle perturbation (creatine kinase-MB isoenzyme (CK-MB), cardiac troponin-T (TnT), and myoglobin) were collected. The ECG revealed short... (More)
Summary Many competitive breath-hold divers use 'glossopharyngeal insufflation', also called 'lung packing', to overfill their lungs above normal total lung capacity. This increases intrathoracic pressure, decreases venous return, compromises cardiac pumping, and reduces arterial blood pressure, possibly resulting in a syncope breath-hold divers call 'packing blackout'. We report a case with a breath-hold diver who inadvertently experienced a packing blackout. During the incident, an electrocardiogram (ECG) and blood pressure were recorded, and blood samples for determinations of biomarkers of cardiac muscle perturbation (creatine kinase-MB isoenzyme (CK-MB), cardiac troponin-T (TnT), and myoglobin) were collected. The ECG revealed short periods of asystole during the period of 'packing blackout', simultaneous with pronounced reductions in systolic, diastolic, and pulse pressures. Serum myoglobin concentration was elevated 40 and 150 min after the incident, whereas there were no changes in CK-MB or TnT. The ultimate cause of syncope in this diver probably was a decrease in cerebral perfusion following glossopharyngeal insufflation. The asystolic periods recorded in this diver could possibly indicate that susceptible individuals may be put at risk of a serious cardiac incident if the lungs are excessively overinflated by glossopharyngeal insufflation. This concern is further substantiated by the observed increase in serum myoglobin concentration after the event. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cardiac markers, apnoea, dysrythmia, glossopharyngeal insufflation, hypotension, syncope
in
Clinical Physiology and Functional Imaging2002-01-01+01:00
volume
29
issue
6
pages
458 - 461
publisher
Wiley Online Library
external identifiers
  • wos:000270645500012
  • pmid:19706046
  • scopus:70350401750
ISSN
1475-0961
DOI
10.1111/j.1475-097X.2009.00892.x
language
English
LU publication?
yes
id
b6a8ad21-8cdb-4b4e-bfa1-ddd26defe4b5 (old id 1469378)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19706046?dopt=Abstract
date added to LUP
2009-09-07 12:07:20
date last changed
2017-09-10 03:46:45
@article{b6a8ad21-8cdb-4b4e-bfa1-ddd26defe4b5,
  abstract     = {Summary Many competitive breath-hold divers use 'glossopharyngeal insufflation', also called 'lung packing', to overfill their lungs above normal total lung capacity. This increases intrathoracic pressure, decreases venous return, compromises cardiac pumping, and reduces arterial blood pressure, possibly resulting in a syncope breath-hold divers call 'packing blackout'. We report a case with a breath-hold diver who inadvertently experienced a packing blackout. During the incident, an electrocardiogram (ECG) and blood pressure were recorded, and blood samples for determinations of biomarkers of cardiac muscle perturbation (creatine kinase-MB isoenzyme (CK-MB), cardiac troponin-T (TnT), and myoglobin) were collected. The ECG revealed short periods of asystole during the period of 'packing blackout', simultaneous with pronounced reductions in systolic, diastolic, and pulse pressures. Serum myoglobin concentration was elevated 40 and 150 min after the incident, whereas there were no changes in CK-MB or TnT. The ultimate cause of syncope in this diver probably was a decrease in cerebral perfusion following glossopharyngeal insufflation. The asystolic periods recorded in this diver could possibly indicate that susceptible individuals may be put at risk of a serious cardiac incident if the lungs are excessively overinflated by glossopharyngeal insufflation. This concern is further substantiated by the observed increase in serum myoglobin concentration after the event.},
  author       = {Andersson, Johan and Linér, Mats and Bjursten, Henrik},
  issn         = {1475-0961},
  keyword      = {cardiac markers,apnoea,dysrythmia,glossopharyngeal insufflation,hypotension,syncope},
  language     = {eng},
  number       = {6},
  pages        = {458--461},
  publisher    = {Wiley Online Library},
  series       = {Clinical Physiology and Functional Imaging2002-01-01+01:00},
  title        = {Asystole and increased serum myoglobin levels associated with 'packing blackout' in a competitive breath-hold diver.},
  url          = {http://dx.doi.org/10.1111/j.1475-097X.2009.00892.x},
  volume       = {29},
  year         = {2009},
}