Cerebral arterial gas embolism and neurogenic stunned myocardium in a previously healthy freediver

Cardiomyopathy is a known but rare sequelae of diving-related cerebral arterial gas embolism (CAGE). In previously reported cases, patient findings have been consistent with takotsubo cardiomyopathy (TCM) per the revised Mayo Clinic’s diagnostic criteria. A lesser-known variant of stress-related cardiomyopathy is neurogenic stunned myocardium (NSM), which occurs after a neurological event such as subarachnoid hemorrhage and typically presents in younger patients. Presentation tends to differ slightly to TCM with non-specific left ventricular dysfunction and T wave inversions. This case adds to the rare numbers of reported cardiomyopathy from diving and is the first reported case of suspected NSM associated with CAGE.

Keywords: barotrauma; breath-hold diving; cardiomyopathy; cardiovascular; cerebral arterial gas embolism (CAGE); electrocardiography; hyperbaric oxygen; neurogenic stunned myocardium; NSTEMI,

pneumomediastinum; snorkeling