This Season Of The Heart
Winter brings cardiac risks that call for special prudence, two Bergen doctors explain.
The phrase “winter blues” usually refers to matters of the metaphorical heart, but make no mistake: The coldest season can spell trouble for your literal ticker as well. Freezing winter weather and its consequences, including both a sedentary, indoor life and the sudden exertion required to shovel heavy snow, can increase your risk of a cardiac episode.
“When it’s cold, your blood vessels can constrict as a way of centralizing the blood to keep your internal organs perfused with blood flow,” explains Vladimir Joseph, M.D., a cardiologist with Hackensack Meridian Health in Hackensack. “The blood vessels in your extremities—your legs, your hands—constrict, bringing blood flow back to the heart. If you have underlying heart disease, this puts an increased stress on the heart, because your blood pressure increases.”
This blood-pressure hike can be especially problematic for some, says Ernest Chang, M.D., a cardiologist with Valley Health System. “If you have a preexisting condition like hypertension, high cholesterol or diabetes, that increase in blood pressure can cause extra stress to the heart. Even if your blood pressure is controlled at baseline, cold weather can increase it and cause symptoms such as lightheadedness, chest than a chilly inconvenience, this chore can put certain people’s lives at risk. The strain of heavy labor, combined with the above-mentioned vasoconstriction and the added weight of protective clothes, can trigger the formation of a blood clot that blocks the artery and causes a heart attack. “Shoveling snow is a very strenuous physical activity,” says Dr. Joseph. “The exertion is intense, and this is compounded by the fact that a lot of people don’t get regular exercise. For people who also have an underlying heart disease, there is an increased risk for cardiac events.”
“You don’t need to stay away from shoveling snow altogether,” says Dr. Chang. “But always dress warmly and take your time. It’s not a race. And if you can’t do it yourself, hire professionals so you don’t overexert yourself in the cold.”
“Underlying risk factors may be undiagnosed or underdiagnosed,” says Dr. Joseph, “because a lot of conditions, such as high blood pressure and coronary disease, can be asymptomatic. People feel like they’re healthy, but they’re not. And when you add that perfect combination of factors, it can lead to events.”
Snowy conditions can also delay lifesaving medical care. Ambulances and other emergency medical services often must travel more slowly, like the doctors and other professionals who need to attend the patient. With a heart attack, explains Dr. Joseph, “Time is muscle,” meaning that every second after the event represents damage being done to that cardiac muscle. Snow takes a bad situation and makes it worse. But you can take steps to reduce the danger, the doctors say:
• Stay (safely) active. “Make sure you’re getting the recommended amount of exercise [the American Heart Association suggests 150 minutes of moderate exercise a week], and remember to do it consistently,” says Dr. Joseph. “I find, when talking to patients, that people treat winter like a true hibernation period. They don’t exercise as much. You don’t need to go out into the cold, but going to the gym or increasing the walking you do at work can make a huge difference.”
• Remember other risks. Any health burden is a heart burden, especially infection. “A viral infection can cause a generalized inflammation, and inflammation can cause heart injuries,” says Dr. Chang. “Patients with existing conditions, such as high blood pressure, historic heart failure or atrial fibrillation, are particularly susceptible to infection with COVID, colds, flu and RSV [respiratory syncytial virus]. It can make heart symptoms worse. It’s never too late to get a flu shot, a COVID vaccine or an RSV vaccine.” To further protect against these viruses, wash your hands regularly with soap for at least 20 seconds. Dry, cracked skin can lead to open portals for germs into the body, so hand lotion is a must as well. A full night’s rest will help your body fight off illnesses. And, Dr. Joseph stresses, listening to your body and getting tested by your doctor is essential. “If you do have symptoms, don’t dismiss them. Have a very low threshold for getting evaluated. Find a doctor you trust and get regular checkups.”
• Know signs of trouble. The first step to surviving a heart attack is identifying that you are experiencing one, and getting help as fast as possible. Familiarize yourself with the symptoms, both common and uncommon. Dr. Joseph explains, “The classic symptom of a heart attack is acute-onset chest discomfort. It’s usually a dull pain. It will worsen with exertion and improve with rest. It’s also associated with shortness of breath and sweating. The pain often radiates—it can go up to the extremities, your back and your jaw.” The more uncommon symptoms, the doctor says, “we see more in diabetics, women and the elderly. They sometimes experience shortness of breath, indigestion, nausea and vomiting and other gastrointestinal symptoms. They may also experience unusual tiredness and fatigue.”
He also says: “It’s always better to err on the side of caution and get any symptoms evaluated right away. If you think you are having a heart attack, call 911 and get to your nearest emergency room as fast as possible.”
