Although heart disease is the leading cause of death for all Americans, it affects women differently than men, and many of the symptoms and signs associated with heart disease may present differently in the fairer sex. 

According to the National Heart, Lung and Blood Institute, heart disease kills one out of four women in the U.S., and heart attacks and their aftermath tend to be more deadly in women. Women also tend to think their symptoms are not those of a heart attack and don't seek immediate care.

For many women, a heart attack may feel like a strange discomfort in the back or some other sign that is easy to ignore instead of crushing chest pain. When women do go to the hospital, healthcare providers may miss the diagnosis of heart attack because the symptoms are not clear. 

Heart disease in many women doesn't occur from obvious blockages in arteries as it does in men. Instead, for women, plaque often spreads evenly along the artery wall or in the smaller arteries. This is called microvascular syndrome. Some experts suggest that changes in hormones connected to aging or inflammation may explain why women's smaller blood vessels are affected.

Subtle signs

In women with microvascular syndrome, blood flow to the heart falls dangerously low. But women don't often feel the "elephant-on-the-chest" pain that takes place when large arteries shut down. Instead, they may have subtle symptoms. They may feel pressure or squeezing or shortness of breath. Symptoms may even pop up elsewhere in the body, such as the jaw. This symptom of jaw pain can also appear in men having a heart attack. Many women feel more tired than normal. Or they feel dizzy or lightheaded. Some may have pain in their stomach and think they have indigestion or heartburn. The stage for heart disease is set before menopause by factors such as high blood pressure, high cholesterol, extra weight (especially around the waist), high blood sugar and smoking. All these factors play a part in plaque buildup.

Warning signs

Women are more likely to have "nonclassic" heart attack symptoms than men. Still, healthcare providers note, unexplained jaw, shoulder, back or arm pain can also signal a man's heart attack even when the classic crushing chest pain is absent.

These are the most common warning signals for heart attack:

• Pain or discomfort in the center of the chest that lasts more than a few minutes or goes away and comes back.
• Chest discomfort with sweating.
• Pain that spreads from the chest to the arm, neck or jaw.
• Shortness of breath, tiredness, dizziness or upset stomach. These are particularly common in women.

If you are at risk for heart disease and have any of these symptoms, call 911 right away. Time is a key factor in a heart attack because the longer the blockage remains untreated, the more heart muscle will die. Also, medicines that break down blockage in the arteries must be given within the first few hours. 

Know your risk factors for heart disease

Preventing or controlling heart disease may mean making changes in the way you live. Risk factors for cardiovascular disease that are specific to women include:

• Being postmenopausal.
• Past hysterectomy.
• Past or current use of birth control pills.
• Pregnancy and the high-risk complications of pregnancy. These include diabetes, pre-eclampsia and eclampsia.

Risk factors for developing cardiovascular disease that both men and women can have in common include:

• Personal history of atherosclerosis, including coronary artery disease, ischemic stroke, and peripheral arterial disease.
• Age over 55.
• Male relative (father or brother) under the age 55 or female relative (mother or sister) under the age of 65 with coronary heart disease.
• High blood pressure.
• High levels of LDL cholesterol or low levels of HDL cholesterol.
• Type 1 or 2 diabetes.
• Chronic kidney disease.
• History of smoking or current smoker or tobacco user.
• Not having an active lifestyle.
• Having a larger body.
• High-fat diet.
• High-stress life.