Be Winter Wise: Woolley Hats Stop Heart Attacks

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Every winter we are bombarded by information about the cold and how to protect ourselves from it and from health issues associated with it.

Wrap up warm, keep one room heated to a minimum 18*C, avoid hypothermia, eat and drink warm food, get the boiler serviced to avoid carbon monoxide poisoning, turn off the Christmas tree lights to avoid fire. It’s endless.

Each winter in the UK upwards of 20,000 extra deaths occur that are attributed in one way, or another to the cold. These are referred to as ‘excess deaths from all causes’ on the official statistics. Now that wording makes it sound like the medics record which deaths are caused by the cold. In some cases they do, but in mostly they don’t, the figure is derived by taking the figure for the deaths recorded during non-winter months and taking it away from the winter tally, the number left is the excess deaths from all causes figure.

Now, some things that happen in winter are fully understandable and clearly lead to more deaths than would occur in drier warmer weather. Road accidents, domestic boiler incidents, house fires, drowning from falling through ice, asthma, pneumonia, falls, influenza and so on all have a higher incidence level in winter than at any other time of year.

There are however other deaths that occur, that are directly attributable to cold weather that never even get a mention as weather related. We are all aware that heavy duty snow shovelling can cause a person to keel over with a heart attack, but this is not the main cause of heart attacks during cold weather. Heart attack and strokes, or to give them their proper names, cardiac arrest and cerebro-vascular accidents (CVA) are responsible for thousands of cold weather deaths each year. They are listed on the statistics as exactly what they are, but as a heart or brain does not have ‘packed up due to cold weather’ stamped on it at autopsy it’s hard to absolutely say the death was caused by the weather.

Even though it was.

These two conditions are entirely different but they do have one thing in common…blood. Both conditions are caused by a clotting of, or restriction of the flow of blood through an organ, namely the heart and/or the brain, and this is where blood supply comes in.

Although blood is a liquid, it’s viscous, it has a stickiness to it that some fluids, such as water, don’t have. Like motor oil, blood becomes more viscous if its left in the open air, and it becomes more viscous when it is cooled, and less viscous when it’s warmed. So, when it’s trundling around in your blood vessels, for the most part all is well, it’s warm and fluid and goes on its way doing its thing.

In some parts of your body blood vessels are far nearer the surface than you might think. Look at the inside of your wrists, your jugular vein that you may see pulsing in your neck. The veins visible at your temples, and in the case of newborns under the thin skin of their scalp. Here the blood dissipates heat far more readily than it does from other parts of your body. When it cools, it becomes a little stickier, a little more viscous. Cool it further still, like on a really cold day, and it becomes even more viscous. Sticky blood cells stick together and form tiny clumps, which turn into bigger clumps quite quickly, certainly within a couple of hours.

So. Let’s have an example.

We’ll call him John. John has a desk job in the city, he travels by train as the congestion charge in inner London is exorbitant.

He is fit, going to the gym three times a week and plays football on the weekend. That and running around after his three kids is enough he feels. He gets up, showers and has a healthy breakfast of whole wheat cereal and fruit, a glass of orange juice and sets off.

He drives to the station, parks and makes his way to the platform. He is wearing a shirt, suit and tie and a thick overcoat. He realises when he is standing on the open platform that he’s shivering, he has left his gloves and scarf in the car and doesn’t have time to fetch them.

Still the train is hopefully running on time and will be here soon. The blood travelling around John’s’ body is cooling as it moves past his unprotected wrists and up to his unprotected neck, a shirt and tie is not that warm, and on to his unprotected head. As it moves back down into the protected areas of his body it warms and becomes more fluid again.

He is shivering which increases his heart rate, making the blood move faster, so more blood is passing the exposed areas more often and passing through the warm areas at a faster rate. After a few minutes his blood is slightly cooler and slightly more sticky than it was when he arrived on the platform. He continues to shiver. A couple of blood cells have agglutinated, clumped together in one of his veins.

He doesn’t know this has happened, he feels nothing, but the process leading to John’s’ possible demise has begun. The longer he stands there in the cold the more cells will bump into the still microscopic clump and stick to it, increasing its size.

At this point there are several scenarios:

1. The clot increases in size lodges in his brain, blocks the flow of blood and he has a stroke. (CVA)

2. The clot increases in size lodges in his lungs and he has a pulmonary embolism.

3. The clot increases in size, lodges in his heart, blocks the flow of blood and he has a cardiac arrest.

4. The train comes, John warms up before the clot increases in size and he survives this particular encounter.

Today is not John’s lucky day. The train is late. The thing with clots is the bigger they get the more blood cells bump into and stick to them. By the time John gets on the train fifteen minutes later the clot is no longer microscopic, but it’s stuck in place for now. John feels a touch off colour but has put it down to the shivering and shaking he has been doing for 20 minutes.

He gets of the train and makes his way to his office, glad to be in the warm at last. As he settles at his desk, he warms up, his blood gets less sticky and starts moving at its proper rate around his body. The clot in his vein gets less sticky also, the clot becomes less stable as his blood warms.

John doesn’t feel too good. He’s a bit pale, his chest is a little tight, the fingers on his left hand feel odd, his left arm is tingling and there’s a weird ache in his jaw. These sensations pass almost as quickly as they arrived so he has another cup of coffee and settles down to get some work done.

Looking out of the window John can see it’s started to snow. An hour later it’s snowing faster and at 4pm he decides to head home, an hour before he usually does but the weather is worsening.

Predictably his train is delayed. Standing on the draughty platform because the waiting rooms are all full of other like-minded individuals, he pulls up his collar and stamps his feet to stay warm. Just as it did in the morning his blood starts to get a bit sticky, it’s not flowing as well as it usually does due to the cold.

The train comes and an hour later he is in his car heading home. It’s only a short journey from the station so the car doesn’t get that warm.

The back wheels of his car spin a bit as he drives up the small incline of his drive. The snow is six inches deep and shows no sign of slowing. He will need the car tomorrow and so decides to play with the kids for half an hour and then clear it off, putting down some rock salt and grit so that it’s clear for the morning.

This time he is prepared for the cold and puts on full cold weather gear. Hat, scarf, gloves and windproof coat. Within minutes he is sweating and feels a little dizzy. His warm blood has destabilized the clot and bits of it are breaking off. With no warning his chest tightens, he tries to shout for help but hasn’t got the breath to do so. Feeling like a huge weight is crushing him he falls sideward, hitting the car, setting of the alarm. By the time his wife comes outside to see why the car alarm is going off John is dead. He was 39 years old.

Many people die each year of cold related strokes, heart attacks and pulmonary emboli. Even wrapped up, some people prone to sticky blood will still die, but a great many more would survive if they dressed in weather appropriate clothing.

It’s not rocket science that the colder it gets the more we need to wrap up. Cover your head neck and wrists when out in extreme cold. The ankles also have vessels near the surface so socks are a must, and boots are needed in the snow or when trouser legs are likely to get soaked exposing the skin to excessive cold. Wearing several layers means you can take something off if you get too hot and makes managing your temperature far easier.

When your mother shouted:

“Don’t forget your hat, scarf and gloves or you’ll catch your death”
She had a point.

Stay safe this winter

Here’s a few more winter related articles you may enjoy:

Winter’s on the way: Things to do before it arrives

Coping with extreme weather when you’re stranded outside

New peppers guide to winter vehicle preparedness

14 simple ways to get ready for winter

Take care

Liz

5 thoughts on “Be Winter Wise: Woolley Hats Stop Heart Attacks”

  1. This may sound stupid but I had absolutely no idea this could happen. As I am out in all weather’s I will change my ways from now on as have been know to go out in freezing temperatures in a t-shirt. I don’t really feel the cold much.
    I have a question : when I am out in cold weather but doing vigorous exercise could this still happen? I get very hot in the winter when I am mucking out my horses. My body temperature is raised so presumably I would be ok?
    Don’t worry I won’t hold you to it if I suddenly keel over! : )

    1. Hi Sue,

      Sorry for the late reply, busy weekend.

      In short yea it can. It’s the initial cooling after being in a warmer environment that causes the problem. Car with the heater on on the way to the field etc, or coming out of a heated house.

      Some people are more susceptible than others but there is no way of telling unless you have been investigated for something else, a DVT for example which should really make the alarm bells ring!

      Getting used to cold is like getting used to everything else and I get entirely how you have given that other Sue is the same because she is out all the time with the beasties.

      I’ll tell you what I tell her: Layer up when you are first there and remove layers as you heat up. If you stop and start to chill put one layer back on and so on. A pain I know but seriously people keel over every year because of this.

      John in the story was a real person…just not called John and he was one of the rare ones where the cause was picked up at PM (post-mortem).

      As you are coastal, as we are…you two Sues really need to share notes…the wind with any rain at all even drizzle will chill you far faster than anything, just saying. Yes I know, I’m a nightmare but you do horses I do horrible deaths, it’s just the way it is lol.

      Have a good well wrapped up day.

      X

  2. Liz

    Your post vindicated me! Everyone makes fun of me when I go out during the winter months. I wear heavy flat soled boots with a deep tread, thick socks, gloves, long scarf wrapped around my neck and of course my hat. I look like I’m ready for the frigid arctic even if I’m nipping into town for milk.

    Several years ago, I went out to the grocery store for something small. I had boots on but no hat or scarf. Had just gotten out of the shower so my hair was still wet. My car hit a patch of black ice and I went sailing down an embankment. Managed to steer the car away from the electric fence and trees but the car was stuck in the snow. I had to crawl up the embankment and call for help. I was so cold my teeth were chattering by the time the tow truck arrived. Never again.

    Go ahead and make fun of me but now I’m prepared to stay warm.

    kk

    1. KK

      Hi, typing one handed because i am eating raspberries and fresh cream and the bowl is in my other hand so excuse typos.I need no accident to encourage wrapping up cold is my nemesis, the biggest hate of my life barring paedophiles

      arghhh…sour raspberry

      sorry, took me by surprise.

      Cold, yes, I hate it with a passion i could happily stay in from the first cold day until the first warm one the following year.

      GLAD YOU GOT OUT OF THE ACCIDENT OK, sorry not shouting lol

      thanks for sharing

      Liz

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