The muted calm after a long and heavy snowfall doesn’t just muffle the everyday sounds of life in your city or neighborhood—it might also cover cries for help coming from snow-shoveling men suffering heart attacks.

Multiple studies over the years have tied the extra exertion from a vigorous bout of snow shoveling to increased risk of heart attack. But a new study from the land of ice and snow has linked the chest clinchers to the day after a snowfall, and particularly to those storms that lasted at least three days. Data from more than 120,000 hospital admissions and almost 70,000 deaths from heart attack in Quebec was analyzed for the study, and limited to November through April, the months that snow falls in the area.

Researchers found that 60% of the deaths came from men, and one third of the heart attacks happening the day after a snowfall, with an even greater connection being made when the snow fell for two to three days, no matter the age, heart disease risk, or additional health problems of the men. The association between snow storms and women however, was modest or even non-existent.

“Men are potentially more likely than women to shovel, particularly after heavy snowfalls," stated Nathalie Auger, M.D., a study author and assistant clinical professor at the University of Montreal Hospital Research Centre in Montréal, Quebec. "Snow shoveling is a demanding cardiovascular exercise requiring more than 75% of the maximum heart rate, particularly with heavy loads."

Before you dust of your shovel and start in on the driveway this winter, remember to follow these tips to keep yourself out of the emergency room, no matter your physical fitness: warm-up beforehand, shovel lots of small loads, take many short breaks, keep hydrated (no, not the yellow snow), and be reasonable about how much snow you need to clear to make it safe. If you feel any chest pain, get lightheaded, have a racing heart, or generally don’t feel well, get to a warm spot and assess whether you need to call for help.