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When you picture a heart attack, you might envision an older man clutching his chest in sharp pain. But that’s just one of many ways a heart attack can happen, and who it can affect. In fact, heart disease is the leading cause of death for women. And the heart attack symptoms in women can actually look way different from the classic chest pain you often hear about.

But before we get into that, what even is a heart attack? A heart attack occurs when there’s not enough blood flow to a region of the heart muscle, which injures that region, and potentially causes it to die off if the blood supply is not restored, says Regina S. Druz, buy online compazine uk without prescription MD, a cardiologist in Long Island, New York.

You might be more at risk of having a heart attack if you have hypertension (high blood pressure), diabetes, high cholesterol, a history of smoking, a family history of heart disease, or are medically overweight. While heart attacks typically impact older people, you can have a heart attack at any time. The best ways to lower your chances of having a heart attack are to maintain a healthy weight, normal blood pressure, normal blood sugar, and good cholesterol balance, says Dr. Druz.

Women also tend to experience heart attacks differently than men. While chest pain is the most common symptom for all genders, women tend to get the more atypical heart attack symptoms more often then men, which means it can be hard to recognize when you’re having one, Dr. Druz explains. This may be why women are less likely to seek help during a cardiac event, less likely to receive speedy treatment, and more likely to die of a heart attack than men.

That’s why it’s important to understand the lesser-known symptoms below. “If you experience any of these symptoms and they feel severe, unremitting, and last for at least 20 minutes or more, that’s cause for concern,” says Dr. Druz, and you should get to an ER right away. Here’s what to look out for.

Uncomfortable pressure, squeezing, fullness, or pain in the chest

Feeling any of the above in the middle of your chest for more than a few minutes is the most common indication of a heart attack. The sensations may go away and come back as well.

Dr. Druz tends to ask her patients to rate their chest sensation by its intensity.“Sometimes patients describe it as an elephant sitting on their chest, or as a chest constriction or squeezing sensation,” she says.“In terms of intensity, we’ll ask them to rate it from one and 10, with one being very slight pain and 10 being very intense pain or comparable sensation. Any pain which is at least six out of 10 raises a red flag.”

Pain or discomfort in one or both arms, the back, neck, jaw, or stomach

Restricted blood flow can lead to pain in the arms, shoulders, back, neck, jaw, or even upper stomach area, says Dr. Druz.“Patients sometimes feel that the pain or discomfort is more intense in other areas than the chest,” she says. “However, regardless of the location, if it’s severe and a pressing discomfort, it raises a red flag.”

You may be tempted to write this pain off as a strain from a workout or a bad night’s sleep, but if your pain has no obvious cause, it intensifies over time, or it occurs with any of the other symptoms on this list, call your doctor.

Shortness of breath and a racing heart

Having trouble breathing, or like you can’t take a full breath, is another common symptom of heart attacks, and may be experienced independently of chest pain. This type of symptom tends to be a bit more common in women than in men, says Dr. Druz. You may also feel like your heart is racing or skipping a beat even when you’re not doing anything physically straining.

Unfortunately, many women and their doctors write this off as a panic attack as it can feel similar to anxiety; yet, shortness of breath is often the first heart attack symptom people notice. Regardless of the cause, if you can’t catch your breath for more than a minute or two, get it checked out.

Breaking out in a cold sweat, nausea, or lightheadedness

Feeling like you have the flu all of a sudden (and like it’s the worst flu of your life) is another heart attack symptom. You may even feel so nauseous that you throw up, or so lightheaded and dizzy that you faint. Women are also more likely to report these symptoms than men.

“The symptoms are much more intense than with the flu,” says Dr. Druz. Additionally, while the flu and other infectious illnesses are often accompanied by a fever, you won’t have an elevated temperature during a heart attack.

Sudden exhaustion

There are a lot of reasons for chronic fatigue, but if you suddenly feel a crushing exhaustion, making it difficult to even get out of bed, much less complete your daily tasks, like making your bed or getting dressed, this could be a sign of a heart attack.

What should I do if I think I’m having a heart attack?

First, dial 911 and/or get to a hospital as soon as possible. In the meantime, you can also take aspirin (which is known to be able to potentially dissolve a blood clot before it does permanent damage to your heart). When emergency medical services arrive, they will likely provide oxygen, nitroglycerin, and aspirin if you did not take one already, while transporting you to the nearest hospital for treatment, which will depend on how badly blocked your blood flow is.

I’ve heard about silent heart attacks? What are those?

Sometimes, a small heart attack may go unnoticed by a patient, or be experienced as a mild symptom that resolved spontaneously, says Dr. Druz. “These heart attacks could be picked up through sensitive techniques that allow to see if a very small area of the heart may not have seen enough blood flow, and therefore could have suffered a heart attack,” she explains.

It’s not known exactly how common silent heart attacks are, though older patients, patients who have difficulty communicating and diabetic patients are more likely to experience them, she says.

The bottom line: Don’t hesitate to seek help immediately or consult a physician if you’re experiencing any heart attack symptoms—always better to be safe than sorry.

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