Swimming in the open sea is a sport that requires additional physical preparation from athletes used to swimming pools due to environmental conditions, such as current, water temperature, wind and physical contact, for example.
In addition to all the challenges, researchers from the Royal United Hospitals Bath and the University of Bath, in the United Kingdom, warn in an article published in the January edition of BMJ Case Reports magazine that sport can cause swimming-induced pulmonary edema (SIPE), also known as immersion pulmonary edema (EPI).
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The unusual condition, which affects less than 2% of swimmers, was first reported in 1989. It is characterized by shortness of breath and coughing, excessive sputum and occasionally coughing up blood when swimming in open water. The symptoms are caused by the accumulation of fluid in the lungs without the person breathing the water.
The cause of the problem is not well understood. Researchers believe that the picture may be related to changes in blood flow and a stronger response of blood vessels in the lung to cold during exercise.
Risk factors
The UK research group states that the main risk factors are prolonged swimming time, low water temperature, high blood pressure or heart disease, the patient’s age and being female. The threat increases significantly following the first episode of SIPE.
“Recurrence is common and has been reported in between 13% and 22% of divers and swimmers who have had edema. Patients should be adequately informed regarding the high risk of recurrence and following an initial episode, they should be assumed to have a predisposition,” the article authors wrote.
The case study of a 50-year-old woman who suffered swimming-induced pulmonary edema in England shows that in addition to the lungs, the heart can be harmed.
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The patient, with no history of health problems, had performed a triathlon test with long-distance swimming in a sea temperature of 17° C. She stopped swimming following becoming out of breath and continued to complain of shortness of breath for days following. The woman claims to have swum three kilometers without problems in the following week, but had shortness of breath and coughing up blood when she tried to swim another 300 meters.
“While swimming on a night dive, I started to hyperventilate and realized I mightn’t swim any further. When I got out, I stripped off my wetsuit and immediately felt my lungs filling with fluid. I started coughing and felt a metallic taste in my mouth. When I got to the light, I might see that my sputum was pink and frothy,” she recalls.
A blood test showed high levels of troponin, a protein found in muscle that can be released into the blood following damage to the heart. Magnetic resonance imaging confirmed myocardial edema, which is swelling in the heart muscle usually associated with the presence of fluid.
Study authors recommend that swimmers who experience shortness of breath or some of the symptoms of the condition while training or performing a race leave the water immediately and seek medical attention if necessary. It is important to investigate the possibility of SIPE and have the circulatory system checked.
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