Paramedic’s Corner: Care of the heart during the cold
By: Gary Carmack
Posted: Saturday, January 10, 2009 7:14 pm
Listening to the wind swirling and howling outside my window, I was thinking what should I write about regarding the cold weather, snow and ice coming? I already submitted an article on Winter Weather Awareness a few weeks ago. Of course, dangerous driving conditions always come to mind.
I thought back to the 2007 Ice Storm Disaster. Some of us emergency workers spent a lot of hours in the Emergency Operations Center (EOC) assisting people. At the end of the disaster I recall those of us who worked in the EOC talking how thankful we were that we had no deaths from the ice storm. However, there was one death during that period with possible in-direct correlation to the storm. A person died from a heart attack while waiting in line to buy a generator. Would this death have happened regardless of the ice storm? That is a question that only God could answer. However, it made me think: if any person dies from the possible upcoming ice storm, what could cause it. Of course the driving concerns are real. But, caring for our hearts in cold weather might prevent unnecessary deaths as well.
Heart attack, sudden death, or acute coronary syndromes can occur at rest or with moderate activity. In medicine a heart attack is called an Acute Myocardial Infarction (AMI) or simply a MI. Acute = an adjective describing rapid onset, or intense symptom, such as severe pain. Myocardial = the heart muscle. Infarction = the death of part of or all of an organ that occurs when the artery carrying its blood is obstructed. Thus AMI = Sudden, intense + heart muscle + death, due to occlusion of a coronary artery.
Heavy physical exertion or mental stress may play a role in many of these tragedies. Yet, one can be resting in their favorite easy chair…relaxed, reading a book, and have a heart attack or sudden death.
Regular exercise appears to be productive in reducing coronary events and perhaps reducing stress—maybe the largest factor is the stress elimination. It is important that we caution our family and friends concerning sudden, abnormal exertion, until they consult with their physician for guidance. A good example would be sudden heavy snow removal or other storm related exertion by an individual not conditioned to heavy exertion.
The cold seems to cause some people to work harder shoveling snow, cleaning ice, perhaps more than normal. Cold weather causes arteries to tighten, a restriction of blood flow and reducing the oxygen supply to the heart. There is increased oxygen demand on the heart as it is working harder to do the cardiovascular systems work and to maintain body heat.
In December and January the cardiac death rate seems to increase sharply. Matter-of-fact in 2004, the cardiac death rate peaked on Christmas Day and New Year’s Day. Exactly why winter is prime time for heart attack is still an evolving story, but many theories exist and research continues.
During the winter months, there is a change in the ratio of daylight hours to dark hours, which changes the hormonal balance, and some of the hormones involved, such as cortisol, can lower the threshold for a cardiovascular event. Studies have shown that heart attacks and complications related to heart disease occur more frequently in the morning hours. In the winter, people tend to exert themselves or do yard work in the morning because it gets dark earlier. This shift of activities to morning hours adds to the normal circadian variation in mornings--further increasing heart rate, blood pressure, and the hormones that lower the threshold for a cardiovascular event. Many researchers believe it is a combination of these factors, and, maybe the holiday stress.
If you have to shovel snow, clean ice or other heavy exertion; beware especially of early morning, start slow and allow the heart to adapt. The heart does better if allowed to adapt to slow and progressive changes, but it has a more difficult time adapting to sudden changes. Shovel snow or ice for 15 minutes, then rest. Don’t overdo it, especially if you are not used to exercise.
Chest pain is the cardinal symptom of an AMI, occurring in 70 % to 80 % of patients. However, be cautious; as some people will suffer only jaw, neck, or arm pain or even just pain to a tooth. The chest pain might be described by the patient as more of a pressure or tightness than actual pain. The pain or discomfort might spread to the back or between the shoulder blades. Some people just feel unusually tired or abnormally weak. If any of these symptoms occur call 9-1-1 immediately and get the ambulance enroute.
When arriving the EMTs & paramedics will initiate early treatment which is called: “MONA.” MONA is an acronym for Morphine, Oxygen, Nitroglycerin and Aspirin. The paramedic will establish an IV life-line for emergency heart medications and a 12-Lead EKG is done to investigate the possibility of AMI and to provide advanced notification to the emergency room. Most importantly the paramedics are ready to initiate emergency CPR, defibrillation, IVs, and life saving rhythm disturbance therapy as needed.