There are few moments more tranquil than watching the snow fall on a quiet winter’s night — until you have to dig yourself out the next morning.

Shoveling snow is not for the faint of heart. In fact, depending on the water content of the snow, the weight per cubic foot can range from just over 3 pounds for fluffy snow to a heart pounding 20-plus pounds for wet snow.

A 2010 study looked at the incidence of snow shoveling injuries in the United States over a 17-year period. It found that about 11,500 people end up in the emergency room each winter due to shoveling injuries, most in the muscle strain and slip-and-fall categories.

While heart attacks accounted for just under 7% of emergency room visits during the study time period, they were responsible for 100% of snow-shoveling-related deaths.

“Several factors come into play when you shovel,” says cardiologist Benjamin Sanchez Jr., MD, with Lehigh Valley Heart and Vascular Institute. “The weight of the snow, coupled with the cold air, plus any risk factors you may have, could trigger a heart attack.”

Gauge your snow shoveling risk factors:

• Are you a smoker?

• Are you sedentary?

• Do you have diabetes or are you diagnosed with prediabetes?

• Do you have angina (chest pain)?

• Do you have hypertension (high blood pressure)?

• Do you have a lipid disorder (high cholesterol)?

If you answer “yes” to any of these, you need to talk to your doctor about whether shoveling snow is appropriate for you.

“Snow shoveling is an aerobic activity, and in some instances would be considered a high-intensity aerobic exercise,” Dr. Sanchez says. “The sudden demand on the cardiovascular system caused by shoveling increases blood pressure, and this pressure can rupture cholesterol plaque that may line your arteries. If that happens, the plaque or a clot can block blood flow to the heart, causing a heart attack.”

If you are shoveling, pay attention to your body for signs of trouble.

Symptoms that demand attention:

• Chest discomfort or pain that lasts more than a few minutes

• Discomfort or pain in one or both arms, the back, neck, jaw or stomach

• Shortness of breath with or without chest discomfort

• Cold sweats

• Nausea

• Lightheadedness

If you or someone you are with experiences any of these symptoms while shoveling (or elsewhere) call 911.

The emergency room at Lehigh Valley Hospital–Carbon is open 24/7 and located at 2128 Blakeslee Blvd. Drive E., Lehighton, Pa.