Dr. Stephen H. Pollock has one order for the two heart attack patients he treated yesterday at St. Joseph Medical Center, after their efforts to dig out of the snow nearly killed them: Put away the shovels.
"I did tell them that they may never shovel again," said the heart specialist with Mid-Atlantic Cardiovascular Associates. "It's the only restriction I put on patients with heart trouble."
Doctors say that snow shoveling can be dangerous - or fatal - for people who have a history of heart disease or risk factors for it, which include smoking, high blood pressure and high cholesterol. Ten percent or more of heart attacks might also be caused by overexertion.
Although snow-shoveling deaths are relatively rare, at least four shovelers have suffered fatal heart attacks in Maryland since Saturday, including a 42-year-old man from Frederick County, a 60-year-old man from Severn and a 64-year-old man from Odenton. Former Anne Arundel County Sheriff Robert G. Pepersack Sr., 61, died after shoveling snow from the weekend's first storm.
The risks of shoveling stem from two factors: the heavy workload and the cold weather.
For people who don't exercise routinely - and some who do - lifting heavy snow for hours is incredibly taxing, not just on the upper body but on the heart.
"What's different about a big snowfall is that this tends to be more exercise than people get in their day-to-day lives," said Dr. Mark Kelemen, director of clinical cardiology at the University of Maryland Medical Center.
"I think the idea is to be cautious. You don't want to overexert. And if you've not been doing regular exercise, you need to be even more careful."
The weather can also contribute: Cold constricts the arteries and reduces blood flow to the heart muscle, which can lead to an irregular heart rhythm and, potentially, a heart attack.
While Pollock advises heart patients not to shovel snow at all, other doctors urge them to be careful when they do.
"We would caution everybody - really any adult over the age of 40 - that potentially has some risk factor for heart disease to use their common sense and to take things slowly and realize that shoveling snow can be a very strenuous activity, especially if you're not used to it," said Dr. Roger S. Blumenthal, head of preventive cardiology at Johns Hopkins Hospital.
Not everyone who has heart disease knows it.
The two men Pollock treated yesterday at St. Joseph were in their 40s and had risk factors for coronary disease, but neither had been diagnosed with it. They felt fine - until shoveling brought on the excruciating chest pain of a heart attack.
The cardiology team performed successful angioplasties on the men Monday to clear their clogged arteries, Pollock said, and both are doing well.
John Jackson, 68, of Hunt Valley has put in two five-hour days shoveling, freeing his two cars, clearing the walks in front of his house and those of his neighbors - even after having undergone triple bypass surgery four years ago.
"My wife is very concerned. She's afraid I'm going to die out here," he said yesterday. "She hollers out every hour to stop and come in."
But Jackson insists he has been taking it easy; he rests every 15 minutes and tries not to fill the shovel too full.
And so far, he said, "I feel fine. But I know a lot of people who felt fine and dropped dead. I'm not afraid of death. I know this is only temporary here."
Ernie Ohler of Rodgers Forge has been shoveling out, too - even at age 93. He doesn't smoke, drinks sparingly and figures he has to dig out the snowdrifts sometime.
"I don't feel it's exerting because when I get tired I just stop and rest," he said. "Shovel a while and rest a while, shovel a while and rest a while."
Area hospital officials said they haven't had many patients in their emergency rooms yet for shoveling-related chest pain or heart attacks. But the number of cases is expected to increase as more people emerge from their homes and begin chipping away at the snow.
Pollock, who was diagnosed with heart disease and has two implanted stents that keep his arteries open, was ordered not to shovel after he was caught at home ignoring his own advice.
"Both my wife and my son said, `You may not.'"
Sun staff writer Frank D. Roylance contributed to this article.