When we think of hearts attacks, we always associate chest pain, 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, there are other, subtle symptoms that can occur hours, days, even weeks before a heart attack. Pamela Kostic, RN, CCCC, Stony Brook Heart Institute Certified Cardiovascular Care Coordinator, explains that a discomfort that you wouldn’t define as “pain” may be felt in other places, like the inner arm — often, but not always, the left arm — or in the jaw or teeth. It may get worse with activity and improve with rest and may come and go, increasing a bit each time it comes. “Symptoms may also feel like indigestion or the flu,” says Kostic, “You may feel extra tired, short of breath or sweaty. Or you may feel anxious, like something is wrong.” While men tend to – but, not always – feel the classic symptoms of chest pressure, squeezing or heartburn, more than 70 percent of women who have heart attacks experience unusual fatigue, shortness of breath, sleep disturbance, a feeling of anxiety, indigestion or back pain as the first symptom. “Since 85 percent of heart damage occurs within the first two hours of a heart attack, it is critical to treat patients as fast as possible, so less heart muscle is damaged,” stresses Kostic.