Mark Turner Consultant Cardiologist

The Heart Centre Spire Bristol Hospital, The Glen
A Centre of Excellence for Cardiology and Cardiac Surgery

Decompression illness (DCI), formerly known as “the Bends”

What is Decompression illness?

Decompression is illness caused by problems during ascent after diving. It can be caused by dissolved nitrogen coming out of solution during ascent, like what happens when you reduce the pressure in a fizzy drink bottle, with bubbles appearing. It can also be caused by lung rupture or pulmonary barotrauma.

Causes of decompression illness include excessive depth and time underwater (dissolving lots of nitrogen), a right to left shunt due to a PFO (where bubbles can miss out the lungs and cause certain types of DCI) and lung disease (causing trapping of gas that expands and ruptures the lungs).

Assessing divers after decompression illness is highly specialised and the differences between the different types are not usually appreciated by doctors, unless they have specific training and experience in diving medicine. Dr Turner has been assessing divers with decompression illness for many years, having started training in diving medicine in 1991 at the Institute of Naval Medicine. Since starting as a Consultant Cardiologist in Bristol in 2005 he has been regularly assessing divers following decompression illness.

NICE Guidelines

NICE Guideline IPG371 on PFO closure for preventing DCI states:

"Patient selection for this procedure should only be carried out by clinicians with specific expertise in decompression sickness, in liaison with an interventional cardiologist."

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Dr Turner has expertise in both PFO closure and decompression illness and receives referrals from diving physicians around the UK and from abroad.

It is important to be assessed by a Cardiologist who has this experience as closing a PFO for a diver with lung disease will not be protective and we have seen divers where lung disease has been the cause of the problem, but was not appreciated at the time, leaving them to suffer a second episode of DCI.