Blogfinger

Snow shoveler faces a couple of thousand pounds of white stuff. Monday.   Blogfinger photo in Ocean Grove.

Ominous truck appears on Main Avenue: maybe a sign to stop shoveling

By Paul Goldfinger, MD, FACC. 2016.

When I was working as a cardiologist, we were wary of snow storms because we knew that we would have to go to the ER to see shovelers who developed chest pains, dizziness, fainting, palpitations and other worrisome symptoms.

But we also knew that the fatalities were usually among those shovelers who simply died while shoveling without any warning symptoms—ie a cardiac arrest due to a major heart  rhythm disturbance.

The early signs of a heart attack are well known, although sometimes they can be misleading.  For example, chest pains may be harmless, due to muscle strain from shoveling. On the other side of the coin, the early signs of a heart problem might be ignored, such as when jaw or arm pain occur without chest discomfort or if you become short of breath.

If you are having symptoms but are unsure, the best bet is to go to the ER.  I could tell you how to analyze your symptoms, but for a lay person: “Better to be safe than sorry.”  Even a physician or a nurse should not attempt a diagnosis on themselves.

If you are thinking about shoveling, there is an important principle that you should know:  silent coronary heart disease  (ie without any warnings) is common, and you might be at risk of dying during shoveling even though your doctor  has said that  you are healthy and even though you feel fine. This is true even if you had a negative stress test and a normal ECG.

Cardiologists refer to “hearts too good to die.” That means that heart disease, where coronary arteries on the surface of the heart develop blockages severe enough to cause sudden death, may be associated with a strong heart, and that the narrowed arteries could have been fixed if diagnosed.

The risk of sudden death during shoveling is particularly relevant for those who have coronary  risk factors:  over age 50—especially males, smokers, high cholesterol, family history of early heart disease, high blood pressure, diabetes, sedentary, obese, and known heart disease. Even those under age 50 might be at risk from shoveling if they have major risk factors.

The best advice: Don’t shovel snow.  Let some kid do it.

This may sound harsh, but I have seen it.   I personally know someone who died suddenly in his 50’s while snow shoveling and without a cardiac history. He was a heavy smoker with very high cholesterol.    I knew two doctors without known heart disease who died suddenly while cross country skiing.   Any strenuous exercise can trigger an event, not only shoveling.

If you do shovel, do not do so after a meal or after having caffeine or nicotine. Pace yourself and rest frequently.  Remember that the stress on your cardiovascular system during strenuous exercise will be especially extreme in cold weather, even if you dress warmly and think that you are protected . The cold air causes your arteries to constrict and your blood pressure and heart rate to shoot up abruptly.  Cover your face.

Here is a true story:    I was making rounds at the hospital  (Dover General in NJ) when I heard the alarm “CODE  18” which indicated someone has had a cardiac arrest or some other life threatening situation.  The code was across the street at a medical facility.  I was in shape and had a negative cardiac history, but I was 54.

I raced out of the building and ran as fast as I could go, and when I reached the scene, others were already initiating care.  But I couldn’t breath, and it wasn’t like my asthma due to cats and pollen.  I quickly recovered, but I told one of my partners who did a stress test that day.  It was positive, and I was sent to NYU where a cardiac catheterization revealed several narrowed arteries.  Frank Spencer MD, the eminent chief of heart surgery there, came down to see me.  He knew me from  surgery referrals which I often sent there.

He came to my bedside, and in his deep southern accent, he said, “Paul,  you need bypass surgery now.”  There were no stents at that time.

As a physician I knew every complication of my situation, so I feared the worst.

But  I survived the operation and spent 3 weeks in the hospital in a room overlooking the East River.   Eileen slept in my room in a recliner chair.  The lengthy stay was because of complications.  My emotions ran the gamut, but I did find out how my patients might feel under similar circumstances.  It also reinforced an old saying:  “Any doctor who tries to be his own physician has an idiot for a doctor.”

20 years after my surgery I got to meet my grand son Noah.

Please click on “email” below and share this with some of your friends.

I hope this article will save someone’s life.  I am retired now, and timely  care gave me many more years.

Noah visits us in Ocean Grove.  Thank you NYU.

CLARENCE “FROGMAN” HENRY  says take  care of yourself—it’s a gift to your loved ones.