Heart disease presents itself very differently in women than in our male counterparts. Numerous biological distinctions exist that make recognizing and treating heart attacks and heart disease in women require a separate, female-specific approach. AfterEllen.com spoke with cardiologist Dr. Waqar Khan, author, Be Heart Smart: Understand, Treat and Prevent Coronary Heart Disease, about what he recommends women learn about heart attack symptoms in the female body based on what he sees in his practice.
More women die of heart disease than breast cancer. This might come as a surprise to lot of people. Breast cancer advocates have done an excellent job in making sure that the communities are aware of the risks of breast cancer and its incidence in women. However, it is also a known fact that the number one killer in women is heart disease, and coronary heart disease specifically.
Common Heart Attack Warning Signs in Women
Heaviness in chest
Burning sensation in chest
Achy feeling in chest
Pain in shoulders
Pain between shoulder blades
Extreme fatigue
Difficulty breathing
By far, the most common symptom of coronary heart disease or CHD is chest pain, which cardiologists call angina pectoris or just angina. You may have a sensation of tightness, pressure, heaviness, burning, or pain in your chest. Some of my patients who are heart attack survivors say it feels like an elephant sitting on their chest. With angina, you can’t make the pain worse by pressing your hand on the area, the way a bruise or pulled muscle would feel tender to the touch. This type of chest pain is often triggered in situations when the heart muscle requires more oxygen, such as when you exert yourself. Exercise, cold weather, mental stress, and sexual activity all place heavier oxygen requirements on your heart.   
Although women in the U.S. are more likely to die of CHD than any other cause, they are less likely to have classic heart attack symptoms. 
For medical professionals, this can present a challenge. Some women who are having a heart attack complain of an achy, heavy, or burning sensation in the chest rather than typical pain. Some may have pain in their shoulders or in between their shoulder blades. Sometimes they just feel unusually tired or sick to their stomach. Others complain about difficulty breathing.
In general, women wait much longer than men to go to the ER when experiencing the warning signs of a heart attack. 
This puts them at greater risk of poorer outcomes. In fact, women are twice as likely to die in the hospital as men are due to heart attack. Women also tend to have heart attacks later in life than men— about 10 years later on average—however, women who have a heart attack before age 45 have a worse prognosis than men.
Regardless of your age or gender, you can take certain measures to increase your chances of surviving a heart attack.
First, remember that time is of the essence. Cardiologists have a saying: “Time is muscle.” This means that in the event of a heart attack, the amount of time it takes to get treatment determines the amount of damage to the heart muscle. The longer it takes to receive treatment, the more heart muscle tissue will die and be permanently damaged. The faster you receive treatment, the less damage to the heart muscle and the better your chances of survival.
Knowing the symptoms and warning signs of CHD and heart attack is critical for survival.
If you’re experiencing any symptoms associated with heart attack, call 911 immediately. Far too many people delay calling for help. I’ve heard every excuse possible from my patients who have had heart attacks but waited to call for help. Some say they felt embarrassed or were afraid of appearing silly. Some were in denial about what was happening to them. Some were so concerned about their many responsibilities—job, family, children, pets, volunteer work—that they thought, “I don’t have time to be in the hospital with a heart attack.” For some, the absence of crushing chest pain made them doubt that they were actually having a heart attack. Some who had atypical symptoms blamed their discomfort on indigestion and hoped it would just go away. Some people were worried about how much money it would cost to go to the hospital.
I cannot stress enough that if you think you are having a heart attack, call 911 immediately.
When you call for help, the 911 operator may recommend that you chew an aspirin while you wait for the ambulance to arrive. Aspirin thins the blood and inhibits platelets from forming blood clots. Chewing the aspirin rather than swallowing it allows it to work faster to thin the blood.
If you have already been diagnosed with CHD, make sure your family is aware of the symptoms and warning signs of a heart attack. Encourage family members to get trained in CPR in case your heart stops due to a heart attack. Talk to your doctor about nitroglycerin tablets to see if you should have them on hand in the event of a heart attack.