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Response to: Correspondence on 'Cardiovascular considerations for scuba divers' by Wilmshurst et al
  1. Jason V Tso,
  2. Joshua M Powers,
  3. Jonathan H Kim
  1. Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Jonathan H Kim, Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA;{at}

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The Authors' reply

In response to our review highlighting cardiovascular concerns associated with scuba diving,1 we appreciate the specific issues raised by Wilmshurst and colleagues in their letter to the editor. Indeed, we acknowledge these authors as established experts in the field of dive medicine and appreciate their extensive contributions in this arena.2 3 We agree with most of their points and additional detail described in their letter. In part, limitations in the degree of detail in our review were necessary for accordance with the desired length of a generalised review piece. The primary purpose of this review was to offer evaluation and treatment guidance to practitioners caring for divers with different types of cardiovascular pathologies. We appreciate the expanded discussion of diving physiology, immersion pulmonary oedema (IPE) and decompression sickness (DCS) and will also take this opportunity to respond to specific comments.

We concur with the expanded explanation of the physiological effects of water immersion by these authors as the degree of detail was beyond the scope of our review, which included numerous aspects of dive medicine relevant to the cardiovascular practitioner. As written in our review and detailed by these authors, intravascular fluid shifts with diving are primarily due to initial water immersion. It should also be acknowledged that the relationship between dive depth and the autonomic nervous system is complex, associated with dynamic changes in heart rate parameters …

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  • Contributors All authors contributed to this letter and approved the final manuscript.

  • Funding This work was funded by the National Heart, Lung, and Blood Institute (grant number: K23 HL128795).

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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