Heavy snowfall, cold temperatures, and low atmospheric pressure during the winter
months have been associated with increased adverse cardiovascular events. However,
only a few cases of the “snow shoveler's infarction” have been reported. The investigators
describe their experience with 6 patients presenting with ST elevation myocardial
infarctions, all within a 24-hour period during an unprecedented snowfall (4 of whom
were shoveling snow), and provide a detailed review of previously reported cases of
snow shoveler's infarction. Consistent with other reports, most patients reported
here had the traditional cardiac risk factors of hypertension, hyperlipidemia, diabetes
mellitus, tobacco use, and sedentary lifestyle. Unique to this case series, however,
was that the 4 patients who had histories of coronary artery disease and previous
coronary artery stenting all presented with subacute stent thromboses documented on
coronary angiography performed emergently. Moreover, these patients constituted 25%
of all subacute stent thromboses diagnosed in the cardiac catheterization laboratory
in the preceding 12 months. In conclusion, these findings suggest that in typically
sedentary individuals with cardiac risk factors or histories of coronary artery disease,
snow shoveling may trigger ST elevation myocardial infarction and therefore should
be avoided. This may be most critical in patients with histories of coronary stent
placement, considering that these findings suggest that snow shoveling may precipitate
subacute stent thrombosis.
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Article Info
Publication History
Accepted:
March 22,
2010
Received in revised form:
March 22,
2010
Received:
January 27,
2010
Footnotes
Dr. Keeley was supported by grant HL097074 from the National Institutes of Health , Bethesda, Maryland.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
