Lethal event in scuba diving with self-contained breathing apparatus: a forensic study

Introduction: In fatal accidents during scuba diving it is necessary to differentiate a death from primary drowning from a secondary drowning death primarily due to other etiopathogenetic factors. The inhalation of water can only be the end point of a series of events alone capable of causing the diver’s exitus. The aim of this study is demonstrate that even low-risk heart diseases in daily life become potentially fatal during scuba diving. Methods: In this case series we describe all cases of death in the course of diving that came to the observation of the Forensic Institute of the University of Bari over a period of 20 years (2000-2020). Judicial autopsy was performed on all subjects with ancillary execution of histological and toxicological investigations. Results: The results of the medicolegal investigations carried out in the complex identified heart failure with acute myocardial infarction as the cause of death in four cases characterized by severe myocardiocoronarosclerosis, a primary drowning in a subject without previous pathological substrate in one case, and a terminal atrial fibrillation induced by acute dynamic heart failure due to functional overload of the right ventricle in one case Conclusion: Our study demonstrates that lethal events during diving are often related to the presence of unrecognized or subclinical cardiovascular diseases. Such deaths could be prevented and avoided if a greater regulatory sensitivity to the prevention and control of diving was encouraged, considering both the inherent risks of this activity and the possible unrecognized or underestimated pathologies.