Just like after the last storm, Craig Lerman shoveled his driveway so he could go to work last Thursday.  By the time he was finished he had no energy, terrible indigestion and a severe pain down his left arm. He knew something was wrong and called his primary care physician who referred him to the Saint Barnabas Medical Center Emergency Department.  Mr. Lerman is one of the more than 11,500 people who suffer a heart attack each year after shoveling snow.
Sabino Torre, M.D., an Interventional Cardiologist at Saint Barnabas Medical Center in Livingston, NJ, has already seen about a half-dozen men this season who all have had heart attacks after shoveling.  “People just do not realize how much exertion is involved with shoveling snow,” Dr. Torre says. A 1996 study of sedentary men, found that their relative heart rates exceeded the upper limits recommended for aerobic exercises after only two minutes of shoveling. 
“When you couple exertion with cold you have a lethal combination,” states Dr. Torre.  In a January 2011 study in the American Journal of Emergency Medicine which examined 195,100 medical emergencies associated with snow shoveling, all of the fatalities were cardiac related.  When your body is cold, particularly, your extremities, your blood vessels constrict adding more stress to your heart.  Dr. Torre cautions people to avoid snow shoveling if you have not had a medical evaluation in the recent past.  “Just like starting a workout program in a gym, sedentary individuals, especially those with risk factors for coronary heart disease such as high blood pressure, diabetes, high cholesterol, smoking or a family history of heart disease, should not shovel snow without being evaluated by your physician at the start of every season,” he said. Furthermore, any individual who experiences any chest discomfort, arm pain, or difficulty breathing while shoveling that does not resolve with rest should be seen in the emergency room and triaged accordingly.
Individuals who have a cardiac history should avoid shoveling.  For healthy individuals who are going to shovel, there are some basic steps people can take to reduce the stress on their heart.  These include:
o       Make sure you are wearing adequate, protective and warm clothing, including a hat, gloves and warm boots. Dress comfortably and warmly, using layers.
o       Stretch out your muscles prior to going out to shovel.
o       Drink plenty of water to make sure you are hydrated. Avoid caffeinated beverages.
o       Start slowly and increase your heart rate gradually.
o       Push the snow instead of lifting it.
o       Take frequent breaks and go inside to warm up. 
“The white snow may look picturesque, but we should not underestimate the lethal impact of shoveling snow,” concluded Dr. Torre.