Winter Warning: Managing Cardiac Risks During Cold Weather and Holidays

Clearing heavy snow by hand—snow shoveling—is linked to an acute, short-term rise in cardiac events among susceptible patients; seasonal counseling during storms and holiday periods is reasonable.

Recent guidance highlights older adults, patients with known coronary artery disease or recent myocardial infarction, those with uncontrolled hypertension, and individuals with low baseline fitness as disproportionately affected.

Cold exposure and exertion provoke peripheral vasoconstriction and sympathetic activation, raising blood pressure and myocardial oxygen demand. Straining and breath-holding during heavy lifts produce Valsalva-like effects that can reduce coronary perfusion. These physiologic responses likely explain observed increases in acute ischemic events among vulnerable patients.

Sustained heavy lifting, repeated rapid bursts of exertion, and breath-holding while clearing wet, heavy snow or negotiating steep driveways most strongly elevate near-term risk. Duration and intensity matter: long shoveling sessions without rest, or multiple consecutive trips to clear driveways, amplify physiologic strain. Unaccustomed, high-intensity snow removal therefore poses the highest immediate threat for vulnerable patients.

Holiday-related factors—psychological stress, increased alcohol intake, disrupted medication schedules, and delays in seeking care—tend to cluster around storms and holidays and appear to produce temporal spikes in acute cardiac events rather than isolated incidents.

For high-risk patients, consider alternatives to manual snow removal (hiring help or using a snow blower) and counsel on short, iterative sessions with rest, warm-up activity, layered clothing, and avoidance of breath-holding or maximal lifts. Reinforce medication adherence and advise prompt evaluation for chest pain, significant dyspnea, syncope, or other concerning symptoms. The combination of exertion and cold can trigger acute events in susceptible patients, making targeted seasonal counseling a high-yield preventive step.

Key Takeaways:

• Hand shoveling can acutely increase cardiac workload and precipitate ischemic events in at-risk patients.
• Cold-induced vasoconstriction combined with exertional strain and breath-holding creates a high-risk physiologic scenario.
• Practical counseling — alternatives to shoveling, paced short sessions with rest and warm-up, layered clothing, and reinforced medication adherence — can reduce near-term risk.