Heart-attack snow: What it is, and how to protect your patients
Key Takeaways
Heart-attack snow is the wet, heavy variety that’s physically taxing to remove.
According to the American Heart Association, heart-attack snow presents cardiac health risks, as well as risk of physical injury.
Even snowblowers can lead to cardiac events in vulnerable patients.
Clinicians can educate patients about the risks, as well as mitigation strategies and techniques.
Are you familiar with the term “heart-attack snow”? It’s the back-breaking, wet snow that’s so challenging to shovel that it can lead to heart-attacks and other cardiac events.
Snow-shoveling that results in cardiac emergencies is alarmingly common, according to the American Heart Association (AHA). Cardiac clinicians are well-positioned to educate patients about the dangers and precautions.
Cardiac dangers from heart-attack snow
The AHA issued a 2021 news release about the cardiac dangers of moving heart-attack snow. This risk is much higher for people who already have heart disease and those not used to strenuous exercise. CDC data indicates that this may be less than a quarter of your patients. Only 23.2% of adults aged 18 or over meet the guidelines for aerobic and muscle-strengthening activity.
"It really is a 'perfect storm' for acute cardiac events."
— Barry Franklin, Ph.D., FAHA
It really is a 'perfect storm' for acute cardiac events.
The AHA researched the heart-related hazards of snow shoveling, issuing their findings in a 2020 scientific statement. Snow shoveling is associated with increased cardiac events soon after a major snowstorm, the AHA found. The study’s authors noted that shoveling heart-attack snow can tax the body more than maximal treadmill testing, especially for those who are not physically fit.
In the news release, lead author Barry Franklin, Ph.D., FAHA, wrote that cold is also a complicating factor, “increasing the blood pressure while simultaneously constricting the coronary arteries. It really is a 'perfect storm' for acute cardiac events.”
Even those with snowblowers are at risk. Using these heavy pieces of steel machinery can spike heart rate and blood pressure.
Related: Nutritional support for cardiac patients: What the research saysAdditional dangers of snow removal
Snow removal poses other health risks as well. Shoveling and using snow blowers are associated with bodily injury, including strains and sprains of the back and shoulders, fractures, lacerations, and finger amputations.
A 2020 Cureus study, examined data from National Electronic Injury Surveillance System ED visits, focusing on snowblower-related injuries from 2003 to 2018. Among the 91,451 mostly male patients, amputations, fractures, and lacerations accounted for 47.6% of the emergency department visits. Injuries stemmed from placing a hand in the snowblower chute, slips and falls, medical events, and other mishaps.
Related: What to do when your patient doesn't trust youTalking to patients about snow safety
Shoveling snow can be a good exercise when it is done safely and correctly. But when people take on more than their bodies can handle and ignore signs they need to take a break, this wintertime task can quickly become dangerous.
Cardiac clinicians may want to counsel at-risk patients on the following: Avoid shoveling first thing in the morning: Most heart attacks occur first thing in the morning when the blood is more likely to clot, according to a 2018 Circulation Research study. Wait until the sun has had a chance to warm things.
Stretch before heading out: Patients should stretch and move before they clear snow. Advise patients to save shoveling for when another adult is home, in case of an emergency.
Stay warm: Cold temperatures and snow can siphon away body heat and lower core temperature. When temperatures drop, heart rate and breathing rates dip, which can lead to heart failure. Advise patients to wear multiple layers and to keep the head, hands, and feet warm.
Lift properly: Demonstrate proper lifting technique. Push snow instead of lifting it. If lifting is necessary, do it correctly—squatting with legs apart, back straight, and knees bent. Pacing and taking breaks are important too.
Use proper equipment: Use shovels that are not too heavy or too long. Use the shovel grip to increase leverage. For snowblowers, follow operating instructions. If the snowblower jams, shut off the machine before removing the debris. Do not remove solid objects with your hands.
Watch for warning signs: Educate patients on the heart attack warning signs. They should call 911 if they or someone else experience chest pain or tightness, shortness of breath, lightheadedness, and dizziness.
What this means for you
The average person is generally not aware that an activity like clearing snow puts a great deal of stress on the heart. Healthcare providers are positioned to educate their patients, especially those with heart problems and/or who do not exercise regularly, about the health hazards of shoveling and using snowblowers. You can also ensure patient safety by sharing advice on safe snow removal.
Sources
1. Franklin BA, Thompson PD, Al-Zaiti SS, et al. Exercise-related acute cardiovascular events and potential deleterious adaptations following long-term exercise training: placing the risks into perspective–an update: a scientific statement from the American Heart Association. Circulation. 2020;141(13) doi:10.1161/CIR.0000000000000749
2. A winter wonderland can turn deadly with heart attacks brought on by snow shoveling. American Heart Association.
3. Loder RT, Solanki D. Events due to snowblower use seen in us emergency departments from 2003 through 2018. Cureus. 2020;12(12):e11836. Published 2020 Dec 1. doi:10.7759/cureus.11836
4. Colas RA, Souza PR, Walker ME, et al. Impaired production and diurnal regulation of vascular rvdn-3 dpa increase systemic inflammation and cardiovascular disease. Circ Res. 2018;122(6):855-863. doi:10.1161/CIRCRESAHA.117.312472