When many people picture a heart attack, they imagine someone clutching their chest and collapsing to the ground, like is often seen in movies and on television. But for many women, heart attacks don’t look like that at all. In fact, women often have symptoms that are quieter, easier to brush off and more likely to be mistaken for stress, the flu or indigestion. Because of this, heart attacks in women are more likely to be missed or treated later than they should be.

One reason women may not realize they’re having a heart attack is that their symptoms don’t always involve severe chest pain. Some women do feel chest discomfort, but it may feel more like pressure, tightness or fullness rather than sharp pain. Others may not feel chest symptoms at all. Instead, the body sends signals that feel unrelated to the heart.

Here are some of the most surprising heart attack symptoms women experience and why they’re so often overlooked:

• Unusual fatigue. This is one of the most common warning signs in women. It goes beyond feeling tired after a busy day. Many women describe sudden and overwhelming exhaustion that makes everyday tasks feel difficult. This type of fatigue can show up days or even weeks before a heart attack.
• Shortness of breath. Feeling out of breath while resting or doing light activity can be a sign of a heart problem. This symptom may happen with or without chest discomfort and is often mistaken for anxiety, stress or being out of shape.
• Nausea, vomiting or stomach pain. Heart attacks in women can feel like a stomach issue rather than a heart problem. Symptoms may include nausea, vomiting or a burning or pressure-like feeling in the upper abdomen. These signs are commonly confused with indigestion, acid reflux or a stomach bug.
• Pain outside the chest. Women are more likely than men to feel pain in areas other than the chest. This can include the neck, jaw, shoulders, upper back or one or both arms. Jaw pain that comes on suddenly or back pain that feels dull and achy can be especially easy to ignore.
• Cold sweat. Breaking out in a cold sweat without exercising or being in a hot environment can be a red flag. This kind of sweating may feel clammy and uncomfortable and is different from sweating due to heat or activity.
• Dizziness or lightheadedness. Feeling faint, weak or unsteady can be another warning sign. Some women feel like they might pass out, especially when this symptom shows up along with others on this list.

Women are more likely to have several mild symptoms at the same time instead of one intense symptom. They may delay care because their symptoms don’t match what they expect a heart attack to feel like. But waiting can be dangerous and may lead to more heart damage.

If something feels off or you suddenly don’t feel right, trust your instincts. Call 911 right away if you notice possible heart attack symptoms. Acting fast can save heart muscle and save your life.

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