Swimming and scuba diving can induce pulmonary oedema in people with apparently normal hearts.^1–,³ Affected individuals are predisposed to developing hypertension¹ and one patient, described in our original report, later had high altitude pulmonary oedema (unpublished observation). Subsequently, nine more patients (four with hypertension) have suffered pulmonary oedema induced by scuba diving and swimming. Three of these individuals also had episodes of pulmonary oedema induced by other triggers (emotional stress, sexual intercourse, and exertion in extremely cold conditions). In addition, three non-divers have had pulmonary oedema precipitated by triggers such as emotional stress (two patients) or sexual intercourse. In all six individuals there was no identified cardiac abnormality; two patients were known to have pre-existing hypertension, two were discovered to have hypertension at presentation, and two were normotensive.

CASE 1

One of the patients, a man aged 61 years, had his first episode of pulmonary oedema, with dyspnoea and haemoptysis, precipitated by an argument. He had bilateral pulmonary crepitations and his blood pressure was 170/100 mm Hg. He recovered after receiving an intravenous diuretic. During the next four years he had three more episodes of pulmonary oedema confirmed on chest x rays, which were induced by swimming on one occasion and by arguments on two further occasions. On the fourth occasion the pulmonary oedema was so severe that he required mechanical ventilation. Cardiac enzymes and ECGs were normal on each occasion. An echocardiogram, left heart …