A few months ago at work, when I rose from my seat and walked a few steps, something felt off. There was a strange pressure in my chest and rib cage, but I ignored it, took my water bottle from the kitchen and returned to my desk.The next day it happened again. There was no pain and my breathing was fine. But whenever I stood up and took a few steps, the odd squeezing would return. I work at a hospital as a neurosurgery coordinator, and the wall was lined with posters about stroke and heart distress signs. I barely glanced at the pictures, having memorized them years ago.I stood in the hallway waiting for the sensation to pass. One of my co-workers, a nurse, saw me and asked if something was wrong. I told her I felt achy in my upper body, and that my neck and chest felt odd. She suggested I go to the ER.“You never know,” she said. I thought it was probably just a pulled muscle, but I followed her advice. I owe her my life.Deaths from heart disease are the number one killer of women, according to the American Heart Association. It causes a third of deaths a year – more than all forms of cancers combined.At the ER, I mentioned the pressure in my chest area so the triage staff ran tests to check for heart trouble. However, they saw nothing abnormal on my electrocardiogram (which measures electric heart rhythm) or troponin levels (a protein blood test used to diagnose heart attacks).The emergency staff sent me home with cholesterol and blood pressure medication. The following morning, I called a cardiologist because I was still having the odd sensation. After checking my arteries with a catheter, the doctor admitted me to the hospital. They had found blockages in two of my arteries; one was in the largest coronary artery, the kind of blockage that leads to so-called “widowmaker” heart attacks.According to the physicians, it was severe enough to discuss heart bypass surgery. Fortunately, a stent was sufficient. The ER staff thought I might have had a heart attack and would have been on my way to another without medical intervention. When I heard the news, I was stunned. I worked in healthcare and was familiar with the signs of cardiac issues. How could I not know my heart was in serious trouble?It turns out that this issue is fairly common. Symptoms show up differently in women – something I am now grateful to know.What heart attack symptoms should women look out for?A heart attack is a specific event, in which the blood flow to the heart muscle is suddenly blocked. (Conversely, heart disease refers to any condition that affects the heart – a common example is coronary artery disease, a buildup of plaque in the arteries. Symptoms for heart attack and heart disease are not the same, but there is some overlap.)Symptoms of heart attacks are different for men and women, according to the American Heart Association.The most common signs for men are pain in the chest, left arm, jaw, neck or back; nausea, vomiting, indigestion; and shortness of breath.For women, the list of possible symptoms is longer: chest pain or pressure in lower chest, upper abdomen, jaw, neck and upper back; nausea or vomiting; fainting and shortness of breath; indigestion or extreme fatigue. Chest pain or pressure is not always present.In addition, issues such as high blood pressure during pregnancy, menopause, hormone replacement therapy and use of birth control should be considered in evaluating overall risk.However, this list is not exhaustive. Women should be prepared to look into other areas that may not stand out as symptomatic. For instance, the heart and stomach share nerves, and many women do not know that indigestion, nausea and GI distress can also be heart disease symptoms, said Dr Sirisha Vadali, a cardiologist at HonorHealth in Scottsdale, Arizona, specializing in women’s heart disease: “Lesser-known external factors are vital to getting an accurate diagnosis.”Vadali also said it’s important to notice even small physical changes that may not seem related to the heart. I told Vadali about my unexpected diagnosis. “I hate to say it, but I’m not surprised,” she said. “I’ve spoken to many women who feel something is wrong, and don’t present the way men do. It’s difficult to explain to medical personnel that nothing really hurts, but your body is telling you there is real trouble-somewhere.”According to the British Heart Foundation, symptoms may come on acutely, like they did for me. Vadali cautions women to take note of any sense that their body is responding differently and consult a medical provider if concerned.“I had one young woman who couldn’t walk up a flight of stairs today, but she did two last week just fine,” she said of a patient who ended up needing prompt cardiac assistance.What tests are helpful for diagnosing heart disease?Vadali mentioned many women dismiss their own symptoms as anxiety, or just assume they are unfit.“There’s an under-appreciation of cardiovascular risks in women,” said Dr Americo Simonini, a cardiovascular specialist with Cedars-Sinai medical center in Los Angeles. Other than the usual sugar, cholesterol and blood pressure checks, what else should we be checking for?“We aggressively measure other things in men that we should be measuring in women,” said Simonini. He mentioned certain types of tests for proteins in the blood and inflammation can present a clearer picture in preventing a future incident, including: