Risks of pulmonary oedema among open-water swimmers
Tuesday January 10th 2023
Older women who take part in open-water swimming may have an increased risk of developing pulmonary oedema, according to a newly reported case study.
*BMJ Case Reports* highlights the case of a fit and healthy woman in her 50s, who encountered breathing difficulties after taking part in an open-water swimming event.
Cardiologist Dr James Oldman, from Bath, reports growing evidence of links between swimming-induced pulmonary oedema (SIPE) and older age, swimming long distances, cold water and female sex. High blood pressure and pre-existing heart disease are also risk factors, he warns.
SIPE was first reported in 1989 and leaves swimmers struggling to draw breath and depletes their blood of oxygen. It affects about 1-2% of open water swimmers, but cases are likely to be underreported, say the authors.
The woman highlighted in the *BMJ Case Reports* was a keen competitive long distance swimmer and triathlete.
She was struggling to breathe and coughed up blood after taking part in an open water swimming event at night in water temperatures of about 17C while wearing a wetsuit. Her symptoms started after swimming 300 metres.
She had also experienced breathing difficulties during an open water swim a fortnight earlier, which had forced her to abandon the event. She reported feeling breathless for some days afterwards.
When the woman arrived at hospital, her heartbeat was rapid, and a chest x-ray revealed pulmonary oedema. Further scans revealed myocardial oedema, but there was no structural heart disease.
Her symptoms settled within two hours of arrival at hospital and she was discharged the following morning.
It is not yet understood what causes SIPE, but it is believed to involve increases in arterial pressure in the lungs secondary to centralisation of blood volume in a cold environment, combined with an exaggerated constriction of these blood vessels in response to the cold and increased blood flow during physical exertion.
But recurrence is common and has been reported in 13%-22% of scuba divers and swimmers, Dr Oldman reports.
The authors advise swimming at a slower pace, accompanied, in warmer water, without a tight-fitting wetsuit, and avoidance of non-steroidal anti-inflammatories, such as ibuprofen, to minimise the risk.
They recommend that anyone experiencing SIPE symptoms for the first time should immediately stop swimming and get out of the water. When out of the water, they should remain sitting up call for medical help, if required.
“The UK Diving Medical Committee has published guidance for divers. However, at present, there are no formal national medical guidelines concerning the recognition and management of this complex condition,” add the authors.
Oldman J, Morwood S, Willis J et al. Myocardial oedema in the setting of immersion pulmonary oedema - Cause or effect? *BMJ Case Reports* 10 January 2022
Tags: Elderly Health | Fitness | Heart Health | Respiratory
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