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Heart doctors explain the precautions you should take when shoveling snow

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When Dr. Nicole Worden was in her cardiology fellowships at the University of Iowa, there was a sense of place to the heart attack patients she saw.

"In the last couple of years, we didn't have that much snow in Iowa compared to here," said Worden, now in her first year of practice as an interventional cardiologist at Essentia Health-St. Mary's Medical Center and Essentia's Grand Rapids Clinic. "In Iowa, people would be fixing their tractor or fixing their combine. That's a little more common."

In her first winter practicing in the Northland, Worden has seen patients every month whose heart attacks came on when they shoveled, she said.

The notion that shoveling could lead to a heart attack is one of those things that everybody knows. It's also one of those things that happen to be factual, according to Worden and Dr. James Mohn of St. Luke's Cardiology Associates.

"We see an increased incidence of people having angina or chest pain or heart attacks while shoveling snow," Mohn said.

There's not a lot of research on the subject, Worden said, and the research that has been done is "observational," not the randomized clinical standards that are the research gold standard.

But the studies that do exist find an increase in heart attacks attributed to people shoveling in the winter, Worden said. There even are some studies that show "the deeper the snow, the more likely the person was to have a heart attack, which makes a lot of sense."

"We typically start to warm up, and then if we get storms - especially later in the month or the beginning of April - the temperatures are often right around freezing," he said. "So you typically get that heavier snowfall that's a little bit harder to shovel."

All of which is to suggest that it's not only too early to put away the shovels. It's also not too late to consider your heart health when shoveling duties beckon. In separate interviews over the phone, we asked Worden and Mohn what people should know. What follows is a summary of their thoughts:

The reasons

• Shoveling snow requires vigorous exertion that deskbound office workers or retirees might not be accustomed to, both said.

• Moreover, it's an activity in which intensity increases quickly, Worden said. Heart rate and blood pressure, therefore, increase rapidly. It also requires arm strength, and most people have more strength in their legs than in their arms.

• Both also said that cold conditions play a role. Cold weather constricts blood vessels and arteries, Mohn said, and that increases blood pressure.

Precautions

• Stay physically active all year long, Mohn advised. "They're going to know what their body cannot do, and they're also going to be more fit and able to do these chores that require exertion when they need to."

• If you know you have blockages in your heart arteries, ask family members or friends to shovel for you, or pay a neighborhood kid for the job, Worden suggested.

• If there's no one else who can do the job, use a smaller shovel, Worden advised. "Using a smaller shovel is going to reduce the work that you do, and if you take your time, you keep away from having chest pain."

• Take frequent breaks, Worden suggested.

• Don't eat a large meal before shoveling, she said, and avoid alcohol. All of that extra food makes your heart work harder. And: "Alcohol makes people feel warmer than they actually are, and when you get cold, you're more likely to have chest pain."

• Start slowly and build into your shoveling, Mohn advised.

• Dress appropriately, Mohn said. Also, breathing cold air can be a problem for people with lung problems and can stress the entire system, so cover up.

What to watch for

• "As the activity is going on, people should realize how they're feeling as far as their body and any aches or pains or breathing difficulty," Mohn said. "Is this normal for them, or is this unusual? Is this something new?"

• Worden: "If you're out shoveling or doing any strenuous physical activity and you have chest pressure or tightness or that feeling of an elephant sitting on your chest, that's something to take note of and to stop exercising or shoveling right away."

• Other symptoms the experts called attention to: Shortness of breath, pain in the arms, pain extending into the jaw. Some people may experience dizziness, cold sweats, nausea or feeling sick to their stomach, Mohn said.

When to call 911

• If you experience some of the symptoms, but they stop when you stop exerting yourself, that's good, Mohn said. If you start again and they recur, you should contact your doctor. If they don't go away when you've stopped exerting yourself, call 911.

• If the symptoms are new to you, call 911, Worden said. She added this rule of thumb: "I would say if you're asking yourself whether you should do it or not, you'd better just do it."

• If you can't stand the thought of an ambulance coming for you, get someone else to drive, Worden said. "Just don't drive yourself, because that puts you and other people on the road at risk."

Learn CPR

• "If your grandpa or your dad is out shoveling and they're having chest pain, there's a chance they could have a bad heart rhythm that could kill them," Worden said. "And if you know CPR, you could be the one who will save their life. I think it's super important for everybody to know CPR for situations like that."

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