02/09/2026
DCS + PFO 🤿
A diver can follow the computer, make a controlled ascent, do a safety stop… and STILL develop decompression sickness.
So where does a PFO fit in?
During a dive, pressure causes more inert gas to dissolve in the body. As we ascend, that gas must be eliminated. Venous gas bubbles can form during/after decompression often without symptoms.
Normally, venous blood returns to the RIGHT side of the heart, then passes through the lungs, which help filter venous bubbles.
Now add a PFO: Patent Foramen Ovale.
Before birth, we all have an opening between the atria. It normally closes after birth, but in roughly 1 in 4 adults it remains open to some degree.
Most never know.
If right-sided pressure temporarily exceeds the left, a PFO can allow a RIGHT → LEFT shunt.
For a diver with venous bubbles, this matters.
Bubbles may cross the PFO, bypass the lungs and enter arterial circulation, potentially reaching vulnerable tissues.
This is associated particularly with cerebral, spinal, inner ear and skin DCS.
But understand this:
PFO ≠ DCS.
Having a PFO does NOT mean you will get DCS. Finding one after DCS does NOT prove it caused the event. DCS also occurs without PFO, and the absolute risk remains low.
Shunt size and behavior matter too. Larger or spontaneous right to left shunts generally raise more concern.
And your dive computer?
It cannot see your PFO.
It cannot measure bubbles in your blood.
It does not know your individual physiology.
It calculates decompression from a MODEL.
Staying inside NDL reduces risk it never makes DCS risk ZERO.
Should every diver get tested? NO.
Routine PFO screening for all divers is not recommended. But after certain DCS presentations particularly cerebral, spinal, inner ear or skin DCS evaluation for a right to left shunt/PFO may be considered with a diving medicine physician.
If DCS is suspected:
STOP diving.
Give 100% oxygen if available.
Contact emergency/diving medical services.
Get evaluated even with a clean computer.
Your computer can show a normal profile while something abnormal is happening inside your body.
Understand the physiology, not just the computer. 🤿🌊
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