You\u2019ve seen it over and over: A male character in a movie or on a TV show is having sex, yelling at someone, playing sports or even riding a Peloton , when all of a sudden, he stops cold. He then goes pale, staggers, clutches his chest \u2014 left arm or both \u2014 then dramatically slides down a wall. You hardly ever see women having a heart attack in pop culture, however, even though almost as many women die of some form of heart disease as men in the United States, according to the Centers for Disease Control and Prevention . In 2017, heart disease killed one in five American women , and it\u2019s not only older women: the proportion of younger women hospitalized for heart attack has been growing, research shows. If you did see a woman experiencing heart attack symptoms in real life, it is liable to look something like this: Two friends are out strolling, when one says she\u2019s just feeling like \u201csomething isn\u2019t right\u201d and suggests they sit for a minute. According to Judith Lichtman, Ph.D., MPH , the Susan Dwight Bliss Professor and Chair in the Department of Chronic Disease Epidemiology at the Yale School of Public Health, you'd see a woman who is feeling abnormally tired and really not up to her normal speed, who is also potentially noticing any of the following common heart attack symptoms: Chest pressure, tightness, palpitations or sharp pain Nausea, indigestion, stomach pain or some acid reflux Discomfort in arms, neck, jaw or back Fatigue Shortness of breath Dizziness or fainting Cold sweat and paleness But because she\u2019s feeling other things in addition to some chest pain or discomfort, unless her friend is alarmed enough to call 911, the woman may well attribute any of these symptoms to exhaustion or the flu and go home and take a nap. And it\u2019s not only the woman herself who may not know she\u2019s having a heart attack: Lichtman\u2019s research suggest that, perhaps because younger women present with more symptoms than men their age, often neither the woman nor her doctors initially think it\u2019s a heart attack \u2014 even though chest pain is the main symptom. What exactly is a heart attack? \u201cA heart attack is anytime your heart doesn\u2019t receive enough blood to stay healthy,\u201d says Karol Watson, M.D ., Professor of Medicine/Cardiology at the David Geffen School of Medicine at UCLA. \u201cThe heart is a muscle, and just like any muscle, requires a constant blood supply to stay healthy and strong,\u201d she says. \u201cIf an area of the heart is deprived of blood for any length of time, it can weaken and die, and when it does, that\u2019s a heart attack.\u201d Blood supply to your heart is slowed or stopped if your arteries become blocked with plaque (a mix of cholesterol, fat and other stuff). There can also be blood clotting around the plaque, which makes it hard for the blood to get to your heart. And once an area of the heart dies, says Dr. Watson, it cannot come back (although the rest of the heart may be able to step up and compensate for the damaged area). What are the first warning signs of a heart attack in a woman? When a woman is having a heart attack, one of the first things she may notice is that she\u2019s feeling incredibly tired \u2014 that is, more tired than the usual work-kids-I\u2019m-in-charge-of-everything kind of tired. \u201cThere\u2019s very good information on what premonitory symptoms that women had prior to being diagnosed, and the most common is overwhelming fatigue,\u201d says Dr. Watson. You might not think you\u2019re having a heart attack when you feel this way, because it could be something else, and frankly, who hasn\u2019t felt totally wiped? But here\u2019s the thing: \u201cIt\u2019s almost always accompanied by something else: Chest pain, chest pressure, shortness of breath, indigestion,\u201d says Dr. Watson. Fatigue, says Dr. Watson, might not be the most prominent symptom, so it\u2019s important to look at the totality of what you\u2019re feeling . \u201cIf you have overwhelming fatigue and any of those other things, that\u2019s a sign that something is off,\u201d she says. The Four "Silent" Symptoms of a Heart Attack In addition to extreme fatigue, here are the most common symptoms of heart attacks in women, according to the American Heart Association , so you know what to look for. Note that you may not have all of them: Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes or goes away and comes back. Pain or discomfort in one or both arms, the back, neck, jaw or stomach. Shortness of breath with or without chest discomfort. Breaking out in a cold sweat, nausea, vomiting or lightheadedness. All of these signs are "silent," in the sense that they are easy to ignore \u2014 especially if you don\u2019t want to believe you\u2019re having a heart attack. Another reason people think of them as silent signs of a heart attack is that individually, these symptoms could all be attributed to other conditions. The chest pain, in particular, may not be the dramatic, elephant-on-my-chest stereotypical \u201cmale\u201d heart attack pain, says Lichtman. And the sheer number of these ambiguous symptoms may be one of the reasons many women don\u2019t know they\u2019re having a heart attack , according to Lichtman\u2019s research \u2014 there are other things bothering them, so they blow off the \u201cchest pain or pressure\u201d symptom, says Lichtman. But when some or all of these symptoms are there at the same time, that\u2019s exactly what a heart attack looks like in women. And when you think about it, any kind of pain or discomfort in the chest should be treated as a \u201cloud\u201d symptom. And whether it\u2019s more like tightness or pressure or feels like a sharp pain, all of that counts as chest pain . \u201cChest pain is still the biggest common symptom of heart attack that both men and women experience, around 80-90% depending on how you collect the information,\u201d Lichtman says. How long can a woman have symptoms or signs of blockage before a heart attack occurs? Is it possible to walk around with heart attack symptoms for a period of time? Yes, but for how long is \u201cimpossible to state,\u201d says Dr. Watson. \u201cEvery woman is different.\u201d That\u2019s why if there are any worrisome symptoms it\u2019s best to get them checked as soon as possible. \u201c The symptoms that should send you directly to get checked out are chest pain, shortness of breath or fainting,\u201d she says. As for knowing whether your blood vessels to your heart are becoming blocked, unfortunately, says Dr. Watson, you probably won\u2019t. \u201cIt\u2019s really hard to know pre-symptoms,\u201d she says, though you and your healthcare provider can be on the lookout if she knows your family history and is monitoring your cholesterol, blood pressure and other heart disease risk factors . \u201cWhat you are going to really feel are the symptoms \u2014 I wish there were an early warning sign but there isn\u2019t.\u201d What women need to know that\u2019s different from men \u201cFor a long time there was a sense that women didn\u2019t have the chest pain that men do, and that\u2019s not true,\u201d says Lichtman. The number one thing women need to know is that chest pain or pressure is in fact one of the symptoms (even if it\u2019s not the biggest or most obvious symptom), even if it doesn\u2019t feel like the stereotype of a crushing weight on your chest. \u201cMy rule is, if you have any symptoms between your navel and your nose, that comes on with exertion and goes away with rest, you have to think about your heart,\u201d says Dr. Watson. The other thing women need to know that\u2019s different from men is that they may have multiple symptoms, and not to disregard the fact that chest pain is one of them. Why? \u201cI think it\u2019s a combination of things,\u201d Lichtman says. \u201cIn the back of people\u2019s minds, especially with younger women, people would rather have something else be the cause than a heart attack,\u201d she says. \u201cThey\u2019d much rather it be, say, indigestion over a heart attack,\u201d so they tend to focus on the less dire possibilities. Doctors, too, may not think \u201cheart attack\u201d if when they hear chest pain as just one of many symptoms. \u201cIt\u2019s different for different providers, but for some, the order in which you hear is the order of intensity,\u201d she says. So if a woman lists chest pressure as third or fourth on the list, it may take the doctor longer to think of a heart attack. The third thing women need to understand is that women with heart attacks have higher mortality rates than men for a variety of reasons, research shows. Calling 911 fast if you show symptoms of a heart attack is one thing you can control. What should you do if you have symptoms of a heart attack? Call 911 \u2014 ASAP . One Swiss study found that women wait almost 40 minutes longer to call for help than men do, perhaps because they don\u2019t recognize the symptoms. Older research shows that calling an ambulance is usually quicker than driving yourself to the ER. That\u2019s because if they know you\u2019re coming, the hospital can prep for you, and you get care along the way. Lead with chest pain or pressure when you get to the hospital and the doctor asks about your symptoms. Even if you have other symptoms, \u201cPut that out first rather than burying it,\u201d advises Lichtman. Don\u2019t play down what you\u2019re feeling. \u201cBe the squeaky wheel,\u201d says Dr. Watson. Dr. Lichtman has done research showing that younger women who need care for a heart attack often don\u2019t want to look alarmist. \u201cDon\u2019t feel bad or think that you don\u2019t want to disturb anyone \u2014 this is our job to save your life,\u201d Dr. Watson says.