Cardiac Demands of Heavy Snow Shoveling

Franklin, Barry A.; Hogan, Patrick G.; Bonzheim, Kim; Bakalyar, Donovan; Terrien, Edward F.; Gordon, Seymour; Timmis, Gerald C.

doi:10.1001/jama.1995.03520350062030

Cited by 57 publications

(9 citation statements)

References 23 publications

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“…The higher cardiovascular strain while exercising in the cold may contribute to the adverse health events among those with cardiovascular diseases [13,14]. For example, sudden or intense exercise, such as snow shoveling [15][16][17][18] or winter sports [19] increase the risk of AMI's. Previous controlled research examining the acute effects of cold alone, and in combination with exercise, among persons with cardiovascular diseases are scant.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular diseases, cold exposure and exercise

Ikäheimo

2018

Temperature

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Both acute and prolonged cold exposure affect cardiovascular responses, which may be modified by an underlying cardiovascular disease. In addition, exercise in a cold environment increases cardiovascular strain further, but its effects among persons with cardiovascular diseases are not well known. Controlled studies employing whole-body or local cold exposure demonstrate comparable or augmented increase in cardiac workload, but aggravated cutaneous vasoconstriction in persons with mild hypertension. A strong sympathetic stimulation of a cold pressor test, increases cardiac workload in persons with coronary artery disease (CAD), but does not markedly differ from those with less severe disease or healthy. However, cold exposure reduces myocardial oxygen supply in CAD, which may lead to ischemia. Exercise in cold often augments cardiac workload in persons with CAD more than when performed in thermoneutral conditions. At the same time, reduced myocardial perfusion may lead to earlier ischemia, angina and impaired performance. Also having a heart failure deteriorates submaximal and maximal performance in the cold. Antianginal medication is beneficial in the cold in lowering blood pressure, but does not affect the magnitude of coldrelated cardiovascular responses in hypertension. Similarly, the use of blood pressure lowering medication improves exercise performance in cold both among persons with CAD and heart failure. Both the acute and seasonal effects of cold and added with exercise may contribute to the higher morbidity and mortality of those with cardiovascular diseases. Yet, more controlled studies for understanding the pathophysiological mechanisms behind the adverse cold-related health effects are warranted.

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Section: Introductionmentioning

confidence: 99%

Cardiovascular diseases, cold exposure and exercise

Ikäheimo

2018

Temperature

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“…Among them, 10 patients had incidental abnormalities that necessitated additional tests after anesthetic evaluation, and only three patients canceled surgery. Bronchiectasis localized to the right lung was identified in the CXR of a 78-year-old man who was in good condition to perform high-intensity work such as snow shoveling (estimated as ≥ 4 metabolic equivalents) (10) . After consultation with the pulmonologist, the specialist instructed us to cancel his cataract surgery.…”

Section: Resultsmentioning

confidence: 99%

Limited Utility of Routine Tests Prior to Ophthalmologic Surgery: An Observational Study in a Japanese Hospital

Matsuo

Takemura

Yamazaki

2021

JMA J

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Introduction: Routine preoperative testing for low-risk surgeries without a clinical indication should be avoided; however, such tests are still frequently performed in Japan. This study was performed to assess the impact of routine preoperative tests in low-risk surgery in a Japanese medical setting. Methods: We performed a retrospective chart review to examine the utility of routine tests with respect to anesthetic management and postoperative complications in all patients aged ≥ 18 years whom ophthalmologists consulted with anesthesiologists before ophthalmologic surgery under general anesthesia. Results: During the 10-year study period, 1,234 anesthetic consultations and 1,211 routine preoperative tests (laboratory tests, chest X-rays, and electrocardiograms) were performed in Toyama University Hospital. In total, 59 patients (4.8% of the study population) canceled surgery after a battery of preoperative evaluation. Among them, 10 patients had incidental abnormalities that necessitated additional tests, and only three patients (0.2%) canceled surgery. In-hospital postoperative complications developed in nine patients (0.7%) whose routine test results made it difficult to predict development of these adverse events. No severe life-threatening events were noted in this survey. Conclusions: Routine tests prior to eye surgery for adults were of low value for perioperative management and prediction of development of in-hospital complications in this Japanese medical setting. Anesthesiologists and ophthalmologists should selectively order preoperative tests based on the medical interview and physical examination.

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“…A major finding of this study is that cardiac events can be associated with the use of snow blowers. Shoveling snow is well-known to be associated with major cardiac events [14][15][16][17][18][19][20][21]. A previous study of 36 snow removal cardiac-related events in the Detroit metropolitan area found that four were associated with snow blowers and 32 with snow shoveling [19].…”

Section: Discussionmentioning

confidence: 99%

“…We have more formally described the association of cardiac events with snow blowers at the national level. Such a finding was unexpected, as one goal of a snow blower is to reduce the physical exertion needed for snow removal [1,9,17,20]. The narrative comments of all 27 patients with cardiac events were reviewed; snow shoveling was not mentioned in any of them.…”

Section: Discussionmentioning

confidence: 99%

“…However, other injuries can also occur such as being hit by a missile ejected from the chute, slipping/falling while using the snow blower, and medical issues such as shortness of breath and cardiac events (myocardial infarction/cardiac arrest). Cardiac events have been associated with snow shoveling [14][15][16][17][18][19][20][21] with four case reports involving snow blowers [19]. In that study, four of 36 cardiac deaths associated with snow removal occurred while using a snow blower [19].…”

Section: Introductionmentioning

confidence: 94%

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Events Due to Snowblower Use Seen in US Emergency Departments From 2003 Through 2018

Loder¹,

Solanki²

2020

Cureus

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To comprehensively analyze emergency department (ED) visits associated with snowblower use in the United States. Methods Data on National Electronic Injury Surveillance System ED visits due to snow blowers from 2003 through 2018 were analyzed by age, sex, diagnosis, anatomic location of the injury, and year, month, or weekday. The mechanism of injury and alcohol use were noted. Statistical analyses were performed, accounting for the weighted, stratified nature of the data. Results There were an estimated 91,451 patients with an average age of 51 years; 91.2% were male. Amputation, fracture, or laceration accounted for 43,524 (47.6%) of the ED visits. The mechanism of injury was placing the hand into the chute (44.5%), a fall/slip (13.3%), medical events (6.1%), and miscellaneous (33.8%). Most (68.9%) occurred at home. Alcohol was rarely involved (0.4%). There were 648 deaths; 647 were due to cardiac events. The five major injury diagnoses were fracture (25.9%), laceration (20.2%), strain/sprain (15.0%), amputation (11.2%), and contusion/abrasion (10.2%); 99.8% of the amputations involved fingers. The incidence of ED snowblower visits was 1.845 per 100,000 US population with no change over time. There was a general correlation between the number of visits and the annual snow cover. Conclusions Ample opportunity for injury prevention exists, as there was no change in the incidence over time. Cardiac events accounted for essentially all of the deaths.

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Cardiac Demands of Heavy Snow Shoveling

Abstract: Heavy snow shoveling elicits myocardial and aerobic demands that rival maximal treadmill and arm-ergometer testing in sedentary men. These responses may contribute to cardiovascular events reported after heavy snowfalls.

Cited by 57 publications

References 23 publications

Cardiovascular diseases, cold exposure and exercise

Cardiovascular diseases, cold exposure and exercise

Limited Utility of Routine Tests Prior to Ophthalmologic Surgery: An Observational Study in a Japanese Hospital

Events Due to Snowblower Use Seen in US Emergency Departments From 2003 Through 2018

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