Another 2-4 inches of snow are expected to arrive in Central Indiana on Friday.

If you are headed out to shovel a path out of your home after the heavy snowfall, the American Heart Association encourages Hoosiers to protect their hearts while shoveling. Shovelers should seek immediate treatment if they experience any signs or symptoms of a heart attack, the American Heart Association says.

Research shows that many people may face an increased risk of a heart attack or sudden cardiac arrest after shoveling heavy snow.

“Shoveling snow can be a very vigorous activity, and you’re basically doing it in a freezer,” says Dr. William Gill, a cardiologist who is president of the American Heart Association board of directors in Indianapolis. “Those conditions can very quickly lead to stress on the heart.”

Here’s everything you need to know about snow removal in Indianapolis.

❄️: Expect more snow Friday in Indianapolis. See the forecast as winter advisory issued

Shoveling heavy snow (4 or more inches of snow, according to the National Weather Service) is a strenuous activity.

According to the American Heart Association, adults over the age of 45 should be cautious when shoveling snow as they may be at higher risk for a heart attack or sudden cardiac arrest as a result of shoveling.

If someone has heart disease, high blood pressure or high cholesterol, they are at a higher risk of experiencing a heart attack or sudden cardiac arrest as a result of shoveling snow.

Depending on where you live, snow removal might be required by your local government — and it may cost you if you don’t.

You may face fines if your local city ordinance mandates they should be promptly shoveled, and Indianapolis does have such an ordinance. Also if someone is injured after walking on a walkway that you should have shoveled, you could be held responsible.

For more information on when snow should be shoveled and how much the fines are, read the article below.

Winter weather: Fined for not shoveling snow? It could happen in Indianapolis

If you decide to hire someone to shovel your driveway, how much can that cost?

According to Lawn Love, the price of snow removal can vary depending on how large of a driveway, how many walkways and how much snow there is to remove.

In general, Lawn Love says the typical cost per visit for snow removal from a driveway can range $45 to $160. Most companies offering snow removal typically charge anywhere from $25 to $75 an hour. The prices could also vary if you add salt application.

If you’re going to shovel your own snow, the American Heart Association suggests these tips to make sure you are doing so safely:

• Give yourself a break. Take frequent rest breaks during shoveling so you don’t overstress your heart. Pay attention to how your body feels during those breaks.
• Don’t eat a heavy meal prior or soon after shoveling. Eating a large meal can put an extra load on your heart.
• Use a small shovel or consider a snow thrower. The act of lifting heavy snow can raise blood pressure acutely during the lift. It is safer to lift smaller amounts more times, than to lug a few huge shovelfuls of snow. When possible, simply push the snow.
• Learn the heart attack warning signs and listen to your body, but remember this: Even if you’re not sure it’s a heart attack, have it checked out (tell a doctor about your symptoms). Minutes matter! Fast action can save lives — maybe your own. Don’t wait more than five minutes to call 9-1-1
• Don’t drink alcoholic beverages before or immediately after shoveling. Alcohol may increase a person’s sensation of warmth and may cause them to underestimate the extra strain their body is under in the cold.
• Consult a doctor. If you have a medical condition, don’t exercise on a regular basis or are middle aged or older, meet with your doctor prior to the first anticipated snowfall.
• Be aware of the dangers of hypothermia. Heart failure causes most deaths in hypothermia. To prevent hypothermia, dress in layers of warm clothing, which traps air between layers forming a protective insulation. Wear a hat because much of your body’s heat can be lost through your head.

The American Heart Association urges people to learn the signs of a heart attack so they can recognize the signs and to call 9-1-1 immediately if they experience any of those signs.

Some heart attacks are sudden and intense like they are shown in movies and TV shows. This is what the American Heart Association calls a “movie heart attack,” where no one doubts what’s happening.

In reality, most heart attacks start slowly, with mild pain or discomfort. Often people affected aren’t sure what’s wrong and wait too long before getting help.

Here are signs that can mean a heart attack is happening:

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath with or without chest discomfort.
• Other signs may include breaking out in a cold sweat, nausea or lightheadedness.

As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Calling 9-1-1 is almost always the fastest way to get lifesaving treatment. Emergency medical services (EMS) staff can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. EMS staff is also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too. It is best to call EMS for rapid transport to the emergency room. If you can’t access EMS, have someone drive you to the hospital right away.

“I can’t stress enough the urgency of getting proper treatment for a heart attack,” Dr. Gill says. “Don’t die of doubt. If you’re experiencing symptoms or something just doesn’t feel right, go get it checked out. Hospitals offer life-saving treatment.”

Jade Jackson and Monahil Ahmad contributed to this report.

Katie Wiseman is a trending news reporter at IndyStar. Contact her at klwiseman@gannett.com. Follow her on Twitter @itskatiewiseman or Bluesky @katiewiseman