The Heart Underwater: Mechanisms and Treatments of Immersion Pulmonary Edema

To examine the pathophysiology, clinical presentation, early recognition, and prevention of immersion pulmonary edema (IPE) in swimmers and divers. Additionally, we give specific attention to tactical athletes who face unique occupational exposures. IPE is increasingly recognized in both elite and recreational athletes. Risk factors include cold water immersion, vigorous activity, and underlying cardiovascular conditions. Emerging data suggest elevated pulmonary artery and left-sided filling pressures during exertion are the key factors in developing IPE and highlight the potential utility of pulmonary vasodilators (e.g., sildenafil) to mitigate its occurrence. Optimized hydration and physical fitness coupled with medical screenings appear critical to reducing IPE risk. IPE poses significant risks, particularly during high-intensity exercise and/or cold-water environments. Early recognition and preventative strategies, including cardiovascular screening and education, are essential. Further research on pathophysiology, risk factors, and treatments will help improve outcomes and guide safety protocols for at-risk populations, especially tactical divers and endurance athletes.