The first time Carol Foreman suffered a heart attack, she didn't even know it.

Tachycardia, which Foreman experienced, is an abnormally accelerated heart rate, usually caused by a cardiac arrhythmia and generally seen in patients with underlying heart disease. Symptoms include a rapid heart beat, dizziness and heavy breathing.

"I felt like I had run a marathon," says Foremen, a 68-year-old grandmother from Edgewood, Wash., who took the incident as a warning sign and visited her physician. "It's terrifying to have the doctor tell you that something is wrong with your heart."

Startling Statistics
More women than ever before, however, are hearing the same news. The statistics are alarming:

• Heart disease is the No. 1 killer of American women.
• One in every three American women dies of heart disease.
• Women's heart disease risk starts to rise in middle age.
• Nearly two-thirds of American women who die suddenly of a heart attack had no prior symptoms.
• Fewer than a third of women in a national survey recognized heart disease as the leading cause of death for American women.
• Only 9 percent of women in a national survey named heart disease as the condition they most fear – 61 percent named breast cancer.

Information like this only makes one want to know more about the problem. It raises such questions as, "Am I at risk?" "What are the symptoms?" and "How can I keep my heart healthy?"

Dr. Ileana Piņa is a cardiologist at Case Western University Hospital in Cleveland, Ohio, and a member of the Heart Failure Society of America's Executive Council. One of the greatest concerns she faces in her work is how many women overlook the most common signs of heart failure.

"They attribute whatever they feel to fatigue, doing too many things at once and come up with many excuses," says Dr. Piņa. "In addition, the symptoms may be a bit different in women than in men, and often physicians may minimize them."

Ignoring the Warning Signs
Jan Richardson certainly minimized her symptoms. For three weeks she attributed the head and neck pain she was feeling to stress and fatigue. By the time her husband finally insisted she go to the emergency room it was almost too late. Three of the arteries in her heart were dangerously clogged. One artery was completely shut, while the other two were 95 percent and 75 percent blocked. She was admitted for a triple bypass the next day.

"It was frightening," says 58-year-old Richardson, who recently celebrated her second post-operative anniversary. "I realized afterwards that I hadn't been feeling well for quite some time, but the changes were so gradual. I just chalked it up to my age or being overweight."

Dr. Dan Fintel, director of the coronary care unit for the Northwestern University School of Medicine in Chicago, Ill., believes that part of the problem lies in the lack of knowledge about just how pervasive heart disease is in women.

"Heart disease ranks as the leading killer of women in the United States, yet many women remain unaware of the potential risk," says Dr. Fintel. "According to the American Heart Association, more than 485,000 women have a heart attack each year, and over a quarter of a million women die annually from heart attacks, killing six times as many women as breast cancer."

Dr. Fintel is quick to note that while we shouldn't take away from the importance of breast cancer awareness, we need to be equally aware of the dangers of heart disease, given its prevalence among women. It is partially due to the lack of knowledge of the causes and symptoms of heart disease that women so easily ignore those symptoms.

Women are more likely to experience shortness of breath, cold sweats, indigestion or gas-like pain, dizziness, nausea or vomiting, unexplained weakness or fatigue during a heart attack than the typical chest pains that most men feel. However, some women report more common symptoms, including discomfort in the back or upper chest, which can spread to pain in the jaw, neck, shoulder or the arm.

"Additionally, it is important to note that studies have shown that women often experience warning signs more than a month before their heart attack, such as unusual fatigue or trouble sleeping, shortness of breath, indigestion or anxiety," says Dr. Fintel.

The good news about heart disease is that, barring genetics or other medical conditions, it is largely preventable.

Fighting Heart Disease
"The best way to fight heart disease is to reduce the risk," says Dr. Fintel. "While many risk factors, such as race and family history, cannot be modified, there are lifestyle changes such as quitting smoking, losing weight, exercising regularly and lowering cholesterol and blood pressure that can reduce the risk of a first or recurrent heart attack."

Since her surgery, Jan Richardson has become increasingly diligent about her health. She has changed her diet, exercises regularly and has regular checkups.

"I wasn't taking care of myself," says Richardson. "The changes I needed to make felt overwhelming, but when you realize that if you don't make significant lifestyle changes you will die, it makes the changes much easier to deal with."

Richardson has become so ardent about heart health that she has begun speaking on her experience and teaching wellness and preventive measures.

"I mostly speak at women's groups, and many of the women are my age," says Richardson. "While I feel that is important, I really want to reach women my daughter's age, women in their 30s who need to begin now in order to make the lifestyle changes that help prevent heart disease."

The first step is to take personal responsibility. Everyone needs to be more aware of how a poor diet, lack of exercise and a high-stress lifestyle can seriously jeopardize heart health. And all women should understand the symptoms of heart failure. Knowing the symptoms may save your life.

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