Heart health calls for caution in the cold

Winter and cold weather can pose serious risks to your health. Shoveling snow can trigger a heart attack; staying in the cold too long without protection can cause hypothermia; and frigid temperatures can increase blood pressure and narrow blood vessels, bringing on conditions like Raynaud’s phenomenon and chilblains.
By taking precautions, however, you can guard against these dangers.
Cardiovascular death rates average 26 to 34 percent higher from January through March, according to a study looking at fatalities in a variety of cold and warm states. The causes of death were heart attack, stroke and general “cardiovascular disease.”
Researchers also found heart-attack risk factors – such as high blood pressure, high cholesterol and extra weight in the midsection – increase during winter, and the chance of a heart attack rose by 7 percent for every drop of 18 degrees Fahrenheit.
Whether cold temperatures are the key factor in cardiovascular deaths or one factor among many, they pose serious risks. Here’s a closer look:
Snow shoveling can increase the likelihood of a heart attack. This is especially true for people with existing cardiovascular disease and those with high blood pressure, high cholesterol or sedentary lifestyles.
For people with heart disease, cold weather makes the heart work harder to generate the same amount of heat the body needs to function.
The result can be angina pains. If the pains are caused by a spasm in an artery, it can lead to a heart attack.

Cold hard facts
If you have a heart condition or have been sedentary take these precautions:
• Use a snow blower or have someone else shovel.
• When shoveling, make sure the load isn’t too heavy, work slowly and take frequent breaks.
• Don’t eat a heavy meal or drink alcohol before or immediately after shoveling.
• Be aware of heart attack warning signs, including discomfort in the chest, shortness of breath and nausea.

Raynaud’s phenomenon
A vascular condition in which blood flow is sharply reduced in response to cold or emotional stress. Cold leads to the narrowing of blood vessels in the hands, toes, face, nose and ears. When the vessels are narrowed, the body wants to shunt blood away from the skin to the internal organs, so your skin loses additional heat. Raynaud’s afflicts an estimated 5 percent of the population. Even reaching into the refrigerator to grab a cold drink can set it off.
Those who have Raynaud’s can lessen its effects by avoiding exposure to cold, stress and certain medications, wearing warm clothing when outdoors with special attention to hands and feet and immediately soaking hands in warm water when an attack occurs.

A vascular condition sometimes confused with frostbite, chilblains is characterized by painful swelling in the small blood vessels of the toes, fingers, nose and ears. Chilblains may result in blue or purplish discoloration, accompanied by burning pain, itching, swelling and/or blisters.
The condition may affect people who shovel without gloves or get icy water in their boots. Symptoms can persist for weeks, and in some cases, chilblains can result in permanent sores that can become infected and lead to amputation. Medications called vasodilators can dilate the blood vessels and reduce pain, facilitate healing and prevent recurrences. If you are susceptible to chilblains, avoid exposure to cold, dress warmly when outdoors, don’t smoke and exercise to improve circulation.
If you think you experience any of these conditions, check with your doctor for a medical opinion. While we can’t control the weather, we can control our response to it. Be cautious in frigid conditions, especially during exertions like shoveling. For information, visit www.cdc.gov for the Extreme Cold Prevention Guide.

A condition in which body temperature falls below 95 degrees Fahrenheit, hypothermia can affect people who spend a lot of time in extreme cold. This can cause heart failure, organ or brain damage or even death. The elderly and children are particularly vulnerable to this condition, because they can get it and not notice it. Hypothermia can even occur in a poorly heated apartment.

Signs of hypothermia:
• Shivering
• Mental confusion
• Stumbling and blue lips
• Extreme hypothermia can trigger amnesia and a faltering heart rate.

To avoid hypothermia:
• Stay indoors in frigid weather
• Keep warm by layering clothing that traps warm air, thus providing insulation
• Wear a hat to prevent heat from escaping
• Don’t drink alcohol outdoors or before going outdoors.

Dr. Amjad AlMahameed is an interventional cardiologist and director of the Vascular Medicine Program at the CardioVascular Institute at Beth Israel Deaconess Medical Center in Boston. Readers should use their own judgment when seeking medical care and consult with their physician for treatment.

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