A heart attack occurs when blood flow to the heart is blocked. Plaque builds up in your arteries, which starts to restrict the blood flow. Eventually over time, this plaque breaks open and causes a big clot, restricting any blood from reaching your heart, causing a heart attack. There are a lot of other medical ways to explain it and nuances to the process, but suffice to say - something happens to the blood supply to your heart, and your heart reacts; it can't survive long without blood supply. This little animation illustrates it really well. Note: Cardiac Arrest is something completely different.

So how will you know if you are having a heart attack? Well, you have been to the movies, haven't you? The only way to have a heart attack is to be arguing with someone and getting more and more agitated until you finally clutch your chest and keel over with your eyes rolling to the back of your head. If this does NOT happen to you, you are NOT having a heart attack. (Shoot - did I forget to write that in sarcasm font?)

Okay, here is the real list. Let us start with the obvious:

•Chest pain. This can be like heaviness, a squeezing, and fullness. It can be sudden and increase; it can come and go after a few minutes. It can be excruciating, or just mildly uncomfortable.

•Shortness of breath. Could be related to the chest pain, or stand all on its own. "Shallow" breathing, unable to get a deep breath, feeling like you just ran up a few flights of stairs.

•Indigestion. Feeling nauseous. Can be sudden, or something that has been there a few hours and you are just now noticing. Kind of like morning sickness, or heartburn, or sour stomach in general.

•Jaw or arm pain. Pain that seems to radiate up into your jaw or down your left arm is a signal something is wrong.

You may have all of these, or just one. And you DO NOT have to have chest pain to be having a heart attack. So those are the biggies - the ones that should tell you immediately something is very wrong and you should be dialing 911. Not dialing your husband or your neighbor...but we will get to that in a minute. What about some other signs?

Some of the more "female signs" that is not as easy to recognize. Ah, here is where it gets tricky - because you are going to read this list and immediately think, you are having a heart attack. Try not to overthink it - you need to know these, but like any medical diagnosis, they can also mean a whole lot of other things. Oh, and? This little list? All these things can start happening weeks before you actually figure out you are having a heart attack.

•Feeling of impending doom. You just feel like something is wrong. Like a sixth sense. A general feeling of dread is the best way to describe it.

•Extreme fatigue. Not just normal tired, but extreme - getting plenty of sleep and yet not being able to keep your eyes open. (Warning! Telling a doctor this - especially a male doctor - may get no bigger reaction than, "Of course you're tired - you're a mom." Switch doctors. I did. You will know if it's ordinary tiredness or something more)

•Back pain. Like menstrual cramp pain or third trimester pain - uncomfortable and irritating. May also have regular, good ole abdominal pain (Can we never have something that DOES NOT have abdominal pain as a symptom?)

•Weakness in your arms. A general feeling that you have lost strength in your arms - like how they feel after a great arm workout.

•Shortness of breath. Not sudden onset, but more so you are noticing you are out of breath more often than not. Hard to walk and talk at the same time.

•Indigestion. Reaching for the Tums after every meal, if that is not always the case, may be a sign that a heart attack is on its way.

It needs to be repeated - all of the above can be other things, too, not necessarily signs you will have or are having a heart attack, but too often, we dismiss all these symptoms - we don't take them seriously. And if we even bring it up to our doctors (on some off-chance you also came down with a raging case of flu that forced you to the doctor otherwise you'd never waste time on an appointment for yourself), we, ourselves, usually say it like this: "I've been really tired and out of

breath lately, but I haven't been sleeping well and life is crazy with the kids, so I'm sure it's nothing." Right? Your doctor is not even going to record that in your chart.

Let us take these symptoms seriously - and if you DO NOT know what is causing you to have that back pain, that indigestion, that shortness of breath - tell a doctor and find out together! Maybe it is reflux, maybe its asthma, but maybe - just maybe - its heart disease and you are on your way to a heart attack. After all, didn't we already learn it is the number one cause of death in women? Why are you so quick to dismiss it as a possibility?

Let us circle back a minute to the heart attack. What do you do if you have those symptoms? Even one of those symptoms?

Here is your list:

•Call 911

That is it. There is no more to the list. Call 911. Don't call your husband and get his opinion on what might be happening. Do not call your boss/friend/neighbor to say you might be late. Call 911. No one else can help you. If your heart isn't pumping blood, guess what? You die. Really, there is no discussion here. I was stupid in my response to my heart attack. I got lucky - like, Powerball lucky. I would never do that again. Therefore, we are clear, then - you are going to call 911. And what are you going to say and do from this point on? This:

Say, "I think I'm having a heart attack. I have x, y, and z symptoms."

You will not say, "It's probably nothing - it's probably a panic attack, but I read this article that said I should call."

When the paramedics arrive, you will do everything they tell you to do. You will not think about your messy house, or your to-do list, or who all to call. You will focus solely on getting help. The rest will work itself out. When you get to the hospital, they are going to start asking you many questions. Do not give typical woman responses, such as, "I'm okay. It's nothing." "I feel okay now - I'm sorry for all the trouble." Or other things similar.

Tell the doctors what you know about how you feel. If at any point they start to treat this as anything other than a heart issue, you need to ask for an EKG. An EKG and blood work are the only two ways to diagnose any heart event. You may or may not get a diagnosis right away. You need to insist on that EKG. Doctors in general, unfortunately, still view heart attacks as a "man's thing," and will not be eager to immediately treat you as a heart case. It is okay to insist. It is okay to say, "Hey - I'm pretty sure I am having a heart attack, and I need you to rule that completely out before you treat me for indigestion." I know, I know - so hard for us to stand up for ourselves is not it? Especially if - Heaven forbid - this turns out to be nothing. My goodness, the ruckus you raised...they will be talking about you for weeks! No. That will not happen. They have much more interesting cases to gossip about, trust me.

Do it for your kids. Because if you do not stand up for yourself, they may send you home. That is what happened to me. Oh, did I not mention that last week when I told you my story? Yes - I was in the emergency room the day before for heart trouble. I had been feeling off for about a week, had excruciating migraine pain, shortness of breath, extreme fatigue, nausea, back pain, weakness in my arms, and a feeling that something was very, very wrong. I had gone to the dentist and my blood pressure was sky high and they insisted I go across the street to the emergency room, so I did. I told them I was sure I was just fine. I did not mention any of my symptoms. They sent me home. Without running any EKGs. The next morning, I saw my doctor to follow up. He told me to get more rest from my kids and gave me a new prescription for my high blood pressure. I had a heart attack in my kitchen 2 hours later while making lunch.

So all this advice I just gave you. I did not just read it on a bunch of medical sites and compile it for you. I am giving you this advice because I cannot even begin to fathom how extremely lucky I was. I did everything - and I mean everything - wrong. And apparently, despite my best efforts, I survived.  Maybe I survived because one of you out there reading this right now just popped another Tums, and cannot get that nagging backache to go away...and now you will take it a bit more

seriously and make a call to get things checked out. Maybe one of you will be making lunch for your kids and will find yourself on the floor, not knowing what to do next - and you will remember my list: Call 911. Together, we'll finally start saving some lives.

Learn more:

www.heart.org

www.goredforwomen.org

www.womenheart.org