While most Americans recognize crushing chest pain as a sign of a heart attack, many don't realize that heart-attack victims are just as likely to feel dizzy, break out into a sweat or experience pain in the arm or shoulder.
"You don't have to have that crushing feeling in the chest," says Dr. Arnold Einhorn, a cardiologist and chief of staff for Orlando Regional Healthcare. "You can have sweating, shortness of breath. You can have abdominal pain. If you're not feeling right, you need to be evaluated."
And there's no time to waste.
Many people never get a second chance to visit the doctor. Fifty percent of men and 64 percent of women who die of sudden heart attacks had no previous symptoms, according to the Framingham Heart Study.
The classic heart attack, it turns out, isn't so classic after all.
"A big misconception is that women and men have the same symptoms when they have heart disease," says Dr. Ken Kronhaus, a Mount Dora cardiologist and spokesman for the American Heart Association.
"Men have the classic elephant-sitting-on-the-chest, crushing chest pain. Women get very different kinds of symptoms. Women will get insomnia, fatigue, nausea, shortness of breath. Because chest discomfort is so much less common, it's very easy to miss heart disease in women."
Heart disease remains the nation's leading killer, but there is good news: You can take steps to avoid having a heart attack.
"I've been practicing cardiology in Central Florida for 20 years, and that is the most frustrating aspect of my job," Kronhaus says. "People feel it's inevitable. They think, 'It doesn't matter what I do.' "
Maintaining a healthful diet and exercising regularly can add years to your life. Eat more fruits and vegetables and fewer animal products (meat, cheese, eggs). If your cholesterol or blood pressure is high, take medication to reduce your risk. Lose weight.
Quit smoking today and your risk of heart disease will drop by 50 percent after one year, according to the American Heart Association. Exercise can also dramatically reduce your risk of having a heart attack. One Harvard study found that women who walked briskly for three or more hours a week slashed their risk of heart disease 35 percent compared with women who walked less frequently.
"Heart disease starts at a very young age, in the 20s and 30s," Einhorn says. "It's a progressive disease that takes years to build up. If you've lived a lousy lifestyle for years, eating the wrong foods, not exercising, it will show up."
Doctors advise patients to study the risk factors. If you have two or more risk factors -- for instance, a family history of heart disease before age 55, combined with high cholesterol -- you're at intermediate risk for a heart attack.
Then have a talk with your doctor.
"There's nothing we can do about our family history," says Kronhaus. "If you did drugs as a young person, we're going to be more concerned at a younger age." Cocaine, for instance, damages the circulatory system. And if patients have two or more risk factors, he suggests taking a baby aspirin daily, a move that will "dramatically" lower the risk of heart attack.
People can reduce their risk by following simple advice.
"It's not rocket science," Einhorn says. "Keep your weight off and get exercise. It's so important, but we have a very sedentary culture. People are not exercising like they should be."