We always associate chest pain with heart attacks, and for good reason, but it’s not the whole story ― especially for women. While chest pain is the most common symptom of a heart attack, women can have symptoms that aren’t related to chest pain at all, says cardiologist Leslie Cho, MD. They need to be on the lookout for other, subtler symptoms.

“Also, we need to dig deeper into the symptom of chest pain for both men and women as it relates to heart attacks,” Dr. Cho says. “It is seldom as dramatic as you might think, and it can feel like pressure or heart burn that comes on over time.”

Below, Dr. Cho discusses three symptoms you should watch for ― and explains how to tell if they’re benign or cause for concern.

1. Unusual fatigue

Like many women, you’re probably busy most of the time. You may take care of a family, run a household, work outside the home and care for aging parents. You are probably also tired a lot of the time. Most likely this is normal.

But, Dr. Cho says, you should pay attention to fatigue if it is new or dramatic. Here’s what to watch out for:

• You are suddenly worn out after your typical exercise routine.
• You aren’t exerting yourself, but have fatigue or a “heavy” chest.
• Simple activity like making the bed, walking to the bathroom or shopping makes you excessively tired.
• Although you feel exceptionally tired, you also experience sleep disturbance.

2. Sweating and/or shortness of breath

As women age, a lack of exercise and gradual weight gain cause issues like shortness of breath. Hot flashes are a common complaint for many women during menopause.

But these symptoms can signal a heart problem when they happen in certain situations:

• Sudden sweating or shortness of breath without exertion.
• Breathlessness that continues to worsen over time after exertion.
• Shortness of breath that worsens when lying down and improves when propping up.
• “Stress” sweat (cold, clammy feeling) when there is no real cause for stress.
• Sweating or shortness of breath accompanied by other symptoms such as chest pain or fatigue.

3. Neck, jaw, back pain

As intricate as our body’s systems are, they are very adept at giving signals when there is something wrong. When there is a problem with the heart, it triggers nerves in that area, but you sometimes feel pain elsewhere.

Pain in the jaw, back or arms may signal a heart condition, especially if the origin is hard to pinpoint (for example there is no specific muscle or joint that aches). Also, if the discomfort begins or worsens when you are exerting yourself, and then stops when you quit exercising, you should get it checked out.

Here are some other signs to look out for:

• Women, in particular, can have pain in either arm ― not just the left one like many men.
• The pain is sometimes sudden, not due to physical exertion, and can wake you up at night.
• You may feel pain that is specific to the left, lower side of the jaw.

What to do if you notice symptoms

Women often say they noticed some of these three warning signs weeks or a month before a heart attack.

The sooner you report a problem, the better the chances are of catching an issue before it becomes a full-blown heart attack. If you experience any of these symptoms, take note and visit your doctor as quickly as possible.

When you see your doctor:

• Bring a list of your symptoms and when they are occurring.
• Talk about stress or anything going on in your life that might contribute to a problem.

Your doctor likely will listen to your symptoms and check your pulse and blood pressure. They may order blood work, which will show whether your heart is damaged.

They also may use an electrocardiogram (EKG) to tell whether the electrical activity of your heart is normal, or an echocardiogram to view images of the heart to see if damage has occurred.

All this is important in identifying any problems and taking steps to intervene before a possible heart attack.

When to call 9-1-1

Get help right away if you have chest pain or discomfort along with any of these symptoms, especially if they last longer than five minutes:

• Pain or discomfort in other areas of the upper body, including the arms, left shoulder, back, neck, jaw or stomach.
• Difficulty breathing or shortness of breath.
• Sweating or “cold sweat”.
• Nausea or vomiting.
• Light-headedness, dizziness, extreme weakness or anxiety.
• Rapid or irregular heartbeats.

This content was originally published here.