Scuba diving with ascending aorta aneurysm

Any type of physical activity that raises your BP should be avoided. Scuba diving does as your body gets stressed by the changes in breathing conditions, pressure differential, etc in your case with some blockage it may stress the heart even further affecting your BP.

I’m not a Dr, used to do scuba, stopped several years ago. i would consult with your Cardiologist (you need someone who specializes in aortic diseases). The size of your aneurysm is still on the smaller side but continual increases in BP may contribute to growth.

My aneurysm was repaired at 5.2, no blockages, but still need to manage my BP as other aneurysms may appear. I do exercise intensely but avoid any exercise that raises drastically my BP.

You seem to have the right care, determining growth rate is critical.

All the best

Everything @houston13 says. An ascending aortic aneurysm at 4.6 cm is not small, and the fact that it’s in the ascending aorta matters. That segment of the aorta is exposed to the highest pulsatile pressures in the body. Unlike the abdominal aorta, the ascending aorta sits inches from the heart and takes the full force of every systolic beat. Growth rate matters, but so do transient pressure spikes.

Scuba diving raises a few specific concerns for people with ascending aortic disease. The biggest is not ambient pressure itself, which increases gradually with depth, but what divers often do unconsciously: breath-holding, straining, heavy finning against resistance, awkward gear handling, and sudden exertion on the surface or during ascent. All of those can trigger a Valsalva-type maneuver that acutely spikes blood pressure. That kind of spike is exactly what stresses the ascending aorta and the aortic wall. Depths around 100 feet also increase gas density and breathing resistance, which can subtly encourage breath-holding or forceful exhalation. Add cold water, task loading, current, or stress, and the physiologic load goes up further. None of that shows up on a stress test in a lab.

I was physically fit when my dissection happened. No warning. No prodrome really. That’s why people like me tend to be conservative once the aorta declares itself. The fact that your team wants six-month surveillance is appropriate, but imaging stability does not mean zero risk in the interim. Dissections and ruptures are often triggered by momentary pressure events, not gradual enlargement alone. Calcium score and coronary plaque add another layer of cardiovascular risk during exertion.

Some people with stable, smaller aneurysms do continue diving under very controlled conditions, but that decision is highly individualized and usually involves explicit clearance from an aortic specialist who understands both diving physiology and ascending aortic pathology. Many general cardiologists simply don’t see enough dissections to fully appreciate how unforgiving the ascending aorta can be.

If I were in your position, I would be asking very direct questions: what blood pressure limits are safe, whether beta-blockade is optimized, whether any activity involving breath control or straining is advisable, and whether shallow, no-stress, no-current dives are materially different from deeper recreational profiles. I would also be brutally honest with myself about how disciplined I can truly be underwater.

I’m not a physician, but I am someone who survived a Type A aortic dissection in 2015 that came out of nowhere and required emergency open-heart surgery with a Dacron graft of my ascending aorta and arch. So I look at questions like this through the lens of lived experience, anatomy, and risk management.
I don’t say any of this to be alarmist. I say it because I survived, and I know how fast things can change when the ascending aorta fails. Knowing about the aneurysm gives you power, but it also calls for respect. Whatever you decide, I hope you make it with full information and a margin of safety that lets you keep enjoying life for many years to come. Peace.

Moonboy;
I hope you never give up on us who have not experienced either a dissection or a rupture and attempt to continue on with our pre-aneurysm activities. You lay out the facts with authority and without emotional exaggeration. As you said, your not a doctor but my guess is that you may be responsible for saving lives that the doctors simply do not have (or take) the time to explain. Such as survival steps when aneurysms show up. It takes time and talent to write up the explanation, for example, for the scuba diving enthusiast and I am certain that everyone who is in the aneurysm "club" appreciates your continued efforts to inform. Thank you!

@moonboy @houston13,
With your helping discussion, I am starting to agree w BP meds and need calcium scoring. Thanks.

I am a 77yo small framed 5’ 115lb female with an aortic root at 3.5cm. & a consistently low BP history of 90/60. My total cholesterol is 229 & LDL is 170. My mother died from a dissecting aortic aneurysm at 84. My cardiologist wants me on two BP drugs (Losartan & Metaprol) & Ezitemide since I have tried statins & cannot tolerate them. My aorta has measured 3.3 for 6 years & my aortic root has measured 3.4,2.8,2.9 & now 3.5cm. Considering the last two Ecco’s, I think this is a mistake & do not think lowering my BP is necessary. Any advice? I am considering a second cardiologist’s opinion.

@fpignanelli controlling BP is the key factor when having an aneurysm but if yours is normally low (those numbers are low) it may seem overkill to give you several medications for it but we don’t have the whole picture.

Getting a second opinion is always good, a cardiologist who specializes in aortic diseases should be able to give you more answers.

If yours are not already (I’m sure you are) make sure you are monitoring your BP daily roughly at the same time everyday before any BP medication and keep a log, that will give the cardiologist a lot of information.