So before you pick up that shovel, consider heeding the advice of cardiologists who want to see you stay out of the hospital this year.

“Patients suffer both heart attacks and angina after shoveling snow,” said Dr. Richard Pomerantz, chief medical officer at Ogden Regional Medical Center, who worked 30 years as a cardiologist. “Snow shoveling is a very strenuous activity, particularly on the heart. It combines both aerobic exercise and isometric together.”

Pomerantz said the combination increases the work the heart has to do significantly and can raise blood pressure as well, especially if it’s cold, as cold temperatures tend to constrict the blood vessels in the body.

“If the heart has blockages in its artery, blood supply from plaque buildup, it can’t get enough blood to maintain this increased work and the heart tissue can suffer from lack of blood,” he said. “This causes chest pain and can also is very severe, lead to (a) heart attack where the artery blocks up completely and some of the heart muscle can die.”

According to the Cleveland Clinic, more than 11,000 people end up in the hospital each year with snow shoveling-related injuries. While most of those injuries are orthopedic in nature, a good portion are from heart attacks.

Data compiled by the Consumer Product Safety Commission indicates snow shoveling cardiovascular injuries accounted for half of the hospitalizations and 100% of the fatalities. Other injuries included back strain, lacerations and fractures. The quantity of the snowfall increased the risk for injury and death. Pomerantz used to practice in Rochester, New York – the Snowbelt – where 130 inches of snow can fall in a season.

“If you have any history of heart disease, refrain from snow shoveling,” he said. “If you are not in shape and not exercising regularly, be very cautious of this activity and certainly don’t overdo it.”

Pomerantz said, if possible, hire a young person to shovel the snow or hire a plowing service. If you have to shovel, take several breaks and dress warmly, including scarves to warm the air you are breathing in. Cold air striking the face can trigger a reflex constriction of the coronary arteries, increasing blood pressure. Also, do not shovel after consuming a big meal and refrain from smoking while shoveling.

If you feel chest pain, shortness of breath, excessive sweating or nausea, stop immediately, go inside and warm up and rest. If the symptoms persist or recur after you rest, call 911.

Anyone with known heart disease, prior heart attacks, angina, heart failure, asthma or chronic obstructive pulmonary disease should not shovel snow. And don’t assume a snow blower will save you. Pomerantz said although self-propelled snow blowers are somewhat easier, they can still be quite strenuous for the heart, especially if there is a lot of snow.