Have you ever seen someone on television clutch the chest, scrunch the face in pain and collapse? That’s how TV shows a heart attack. Although they really can look like that, heart attacks often have symptoms that are easy to miss—especially in women.

Heart disease is the leading cause of death in the United States overall for both men and women, and for most races and ethnicities. That makes February—American Heart Month—an important time for every American to understand the risks of heart disease.

What Is a Heart Attack?

The heart, like all the rest of the tissue in your body, depends on oxygen to work. Blood carries oxygen throughout the body. Oxygen-rich blood flows through the coronary arteries, which wrap around the outside of and feed the heart. 

A heart attack happens when one or more of these coronary arteries get blocked. Blood can’t bring oxygen to the heart, and the muscle tissue—the heart is a muscle—begins to die. Heart attacks can be fatal if too much muscle tissue is destroyed. Even when they’re not fatal, heart attacks can severely limit the amount of work the heart can do.

Heart Attack Causes and Risk Factors

That television program may show a heart attack as one big event, but it doesn’t show all the years of buildup—literally. Eating an unhealthy diet can cause cholesterol to build up in the coronary arteries, making them stiff and brittle. 

If some of this cholesterol stuck to the artery wall breaks open, the body sees that as an injury. Blood and chemicals rush to the area and create a clot to stop what your body thinks is bleeding. If the clot is big enough, it can partially or even fully block blood flow to the heart. 

Several factors increase the risk of heart attack. Some of them, like your age and a family history of heart disease, you can’t do anything about. Many more, though, can be reduced with healthy lifestyle choices. 

Risk factors include: 

  • Age
  • Smoking
  • High blood pressure
  • High cholesterol
  • Family history
  • Obesity
  • Diabetes
  • Lack of exercise
  • Stress
  • Using illegal drugs

Heart Attack Symptoms

Your television show from earlier got one thing right: Chest pain is the most common symptom of a heart attack for both men and women. There are other signs and symptoms (your doctor will call them “atypical” symptoms, meaning they’re not as common as chest pain), and it’s important to know that women are less likely than men to have chest pain and more likely to have atypical symptoms. 

Besides chest pain, heart attack symptoms can include: 

  • Pain in the neck, jaw or arm (usually but not always the left arm)
  • Nausea and vomiting
  • Heartburn or acid reflux
  • Severe anxiety
  • Sudden and unexplained fatigue
  • Cold sweat
  • Shortness of breath
  • Dizziness

Heart disease, including heart attacks, are often thought to be problems more for men than women, but this isn’t true. Heart disease is the number one cause of death for women as well. In fact, women are more likely than men to die within a year of a heart attack. 

When it comes to heart attack symptoms, the most common for women (and men) is chest pain, but women are more likely to have atypical symptoms, especially anxiety, shortness of breath and fatigue.

Am I Having a Heart Attack?

Whether you’re a man or a woman, be on the lookout for chest pain, especially if it happens with other heart attack symptoms. If you think you or someone around you is having a heart attack, don’t wait: call 9-1-1 right away. 

Heart doctors have a saying: “Time is muscle.” That means the sooner you can get treatment, the more heart muscle you’ll be able to save. Don’t drive yourself or someone else to the hospital unless you have no choice. When you call 9-1-1, first responders will be able to begin treatment on the way to the emergency room.

How to Prevent a Heart Attack

Habits that build a healthy heart are the same that make the rest of your body healthy. Many of these heart health tips are simple, but that doesn’t mean they’re easy to do. 

Get enough exercise. The Centers for Disease Control and Prevention recommends getting at least 150 minutes of moderate exercise a week

Eat a heart-healthy diet. A heart-healthy diet is one that’s high in fiber, lean meat, fruits, vegetables and healthy unsaturated fat from sources like nuts and fish. Avoid saturated fat, processed foods and sugary drinks, and take it easy on the steak and bacon. Think Mediterranean diet and similar ways of eating.

Keep a healthy weight and BMI. Getting exercise and eating right will largely take care of this. Obesity raises the risk of heart attacks. Aim to keep a body mass index (BMI) of between 18.5 and 24.9

Get tested. Make sure to stick to a consistent healthcare schedule. By going to your annual physicals and other maintenance appointments, you’ll learn if you have a high risk factor such as high cholesterol, high blood pressure or high blood sugar (which causes diabetes). If any of those measurements are high, you and your healthcare provider can work together to lower them with lifestyle changes and medications. 

Don’t smoke. If you needed another reason to quit, you’ve got one. Smoking makes the arteries stiff and increases the risk of a heart-attack-causing plaque rupture. 

If you are concerned about your heart health, request an appointment with your healthcare provider. You and your doctor can decide what steps to take based on your current heart health.