It’s true: Women are different from men, not least of all when it comes to heart attack symptoms. Once considered almost strictly a man’s problem, we now know that anyone can have a heart attack.

Rosie O’Donnell had a heart attack in 2012, and like most women, she didn’t experience the classic, chest-clutching “Hollywood Heart Attack.” Instead she had aching in her arms and chest along with nausea and clammy skin, and like many women didn’t realize what was happening.

Heart disease is now the number-one killer of women. Know the signs of heart attack, and call 9-1-1 if you or someone you know has one or more of the following symptoms.

Dizziness or light-headedness

Feeling dizzy or light-headed is another almost unknown symptom of heart attack.

One study found that 39% of women having a heart attack reported feeling this way as the attack progressed. Another study found that women were actually more likely than men not only to feel dizzy, but even to faint.

This is likely the result of a blockage in one of the blood vessels leading to the heart.

Cold sweats

Rosie O’Donnell reported feeling “clammy” when she was experiencing her heart attack and, among women, this isn’t unusual.

Be wary if you suddenly break out in a cold sweat, especially if you’re sure you’re not going through menopause. Fortunately, this may be one symptom that actually gets you to the hospital sooner rather than later.

One study of about 1,000 patients found that those who experienced sweating, among other symptoms, were less likely to delay getting to the hospital.

Flu-like symptoms

Other vague, but possibly life-threatening signs of a heart attack are flu-like symptoms that can also include tiredness.

“If you feel like you just cannot do what you can normally do in a given day, you should consider that it’s your heart,” says Suzanne Steinbaum, DO, director of women and heart disease at Lenox Hill Hospital in New York City. “This is one of the most common complaints in women.”

Don’t ignore it!

Fatigue and sleep problems

Many women—about half—experiencing a heart attack report fatigue that comes on suddenly and has no apparent cause.

One study of 515 women who had had a heart attack found that 70.7% reported fatigue more than one month before the event.

This study also found that about half had trouble sleeping. Any abrupt changes in sleep patterns could be a warning sign.

Nausea, vomiting, and upset stomach

According to the U.S. Department of Health & Human Services Office on Women’s Health, women are twice as likely as men to experience nausea, vomiting, or indigestion-like symptoms, such as heartburn, while having a heart attack.

This is often because the blood supply to the right coronary artery, which extends to the bottom of the heart, is blocked, Dr. Hayes explains. Unless they’re also having chest pain, many women write it off as something they ate when they should be calling 9-1-1, she adds.

Upper body pain

Pain in the neck, back, jaw, teeth, arms (typically the left) and shoulder blades is a frequent symptom of heart attack in women.

This is called “radiating” pain and is due to the fact that the heart has many fewer nerve endings than, say, the fingertip, where pain will be localized, Dr. Hayes explains.

“When the heart is being injured, pain can be felt in other areas,” she says. Generally, though, pain related to a heart attack is confined to the upper body. It’s not likely to travel below the belly button.

Chest pain and pressure

Classic chest pain may not be the hallmark symptom of a heart attack in women, but it certainly happens.

“There are huge overlaps between men’s and women’s symptoms,” Dr. Hayes says. Any acute chest pain or pressure, such as the classic “feeling like you have an elephant standing on your chest” deserves prompt attention.

“Regardless of what the symptom is, if it’s something new and it’s not going away, it’s better safe than sorry,” Dr. Hayes says.

Shortness of breath

One study found that 42% of women having a heart attack had shortness of breath.

Although men also have this symptom, women are more likely to have trouble breathing without concurrent chest pain, says Sharonne Hayes, MD, founder of the Women’s Heart Clinic and a cardiologist with the Mayo Clinic in Rochester, Minn.

The difficulty breathing is usually sudden and may come on for no apparent reason and in the absence of exertion.

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