The carbon dioxide scrubber in the divers rebreather is failing to remove sufficient carbon dioxide from the loop (higher inspired CO2), or the breathing gas is contaminated with CO2. The diver is overexercising, producing excess carbon dioxide due to elevated metabolic activity and respiratory gas exchange cannot keep up with the metabolic production of carbon dioxide. Gas density limits ventilation at high ambient pressures. The density of the breathing gas is higher at depth, so the effort required to fully inhale and exhale increases, making breathing more difficult and less efficient (high work of breathing). Higher gas density also causes gas mixing within the lung to be less efficient, thus increasing the effective dead space. The diver is deliberately hypoventilating, known as "skip breathing". Skip breathing
Skip breathing is a controversial technique to conserve breathing gas when using open-circuit scuba, which consists of briefly holding ones breath between inhalation and exhalation (i.e., "skipping" a breath). It can lead to CO2 not being exhaled efficiently. The risk of burst lung (pulmonary barotrauma of ascent) is increased if the breath is held while ascending. It is particularly counterproductive with a rebreather, where the act of breathing pumps the gas around the "loop", pushing carbon dioxide through the scrubber and mixing freshly injected oxygen.In closed-circuit rebreather diving, exhaled carbon dioxide must be removed from the breathing system, usually by a scrubber containing a solid chemical compound with a high affinity for CO2, such as soda lime.
Diagnosis
Lutembachers syndrome is diagnosis primarily by physical examinations for heart sounds, electrocardiograms, chest radiogram, transthoracic or transesophageal echocardiography, color flow mapping, and Doppler imaging. Use of the various test can help to differentiate other possible conditions such as mitral regurgitation, Ebstein disease, ventricular septal defect (VSD). Physical examinations
A physical examination will be done to check for abnormal heart sounds, condition of heart, blood pressure, lungs, palpitations, edema, weight gain, ascites, or any other abnormal symptoms. Blood may also be drawn to help determine the cause of fatigue, determination of ascites, other health problems that maybe closely related to cause the symptoms such as kidney, liver, immune (signs of rheumatic fever), abnormal glucose levels. Electrocardiograms
Electrocardiogram (ECG) is used for determination of the location, size, direction of blood flow through the atrial hole, hemodynamic of the right ventricle (blood circulation), tricuspid valve, and functioning of left ventricle. The ECG can also be used to determine the rhythm of the heart to determine if there is an indication of sinus rhythm or atrial fibrillation. In the ECG, the p wave morphology will be study for any abnormalities. If during the ECG, the P-wave (atrial depolarization) is tall, broad, or split waves in lead II and accompanied with a deep negative force in V1, this would be considered to be abnormal; only one wave should be associated with the P-wave. Additionally, in an ECG the QRS morphology and axis will be examined for any abnormalities.