Coronary-Plaque Rupture in Acute Coronary Syndromes Triggered by Snow Shoveling

To the Editor: The acute coronary syndromes — myocardial infarction, unstable angina, and sudden cardiac death — have been shown to be triggered by heavy physical exertion, including snow shoveling, 1 anger, and other types of emotional or physical stress. 2 Although the underlying mechanism has been postulated to be rupture of a vulnerable coronary plaque and the development of intraluminal thrombus, such acute coronary changes have not been demonstrated in living patients. During the blizzard and subsequent snowstorms that affected New Jersey in 1996, 19 patients (16 men and 3 women; mean age, 61 years [range, 40 to 78]; 9 with . . .