We’ve seen the movies and TV shows. Our hero has a heart attack, is brought back by CPR, jumps up, and continues the fight against evil. A victim has a dramatic, chest-clutching moment before succumbing. Every year, more than 805,000 Americans have heart attacks, according to the American Heart Association—and the reality often doesn’t match the media portrayal. As a result, more than half of heart attack victims don’t recognize the symptoms, leading to unnecessary delays in diagnosis and treatment.

What’s more, heart attack symptoms vary depending on whether you’re male or female. The chest-clutching, fall-to-the-ground type—the one we see on TV—happens to men more often than to women. Typically, men experience chest pain or pressure. They may have pain in other parts of the upper body, one or both arms, the back of the neck, jaw, or stomach. There are a host of other symptoms that you can find on the American Heart Association site here.

Women’s heart attacks often set off more diffuse symptoms, which we wouldn’t necessarily recognize as signs of a cardiac event. The Mayo Clinic points out that, in addition to chest pain, women may feel shortness of breath, abdominal pain or heartburn, nausea, dizziness, or fatigue. Fatigue? A heart attack? Yes. Actress Rosie O’Donnell had a heart attack at age 50, triggered by physical activity; she was assisting a woman who was stuck in her car. O’Donnell’s symptoms were nausea, clammy skin, and soreness, and she didn’t think of a heart attack. Who would? But the following day, a visit to her cardiologist showed a blocked artery. At age 71, actress Susan Lucci felt pressure on her chest for a few weeks but dismissed the mild symptoms. After all, she had just had a great checkup. It wasn’t until she felt pain like, she said, “an elephant sitting on her chest,” that she went to the hospital. Doctors found large blockages in two arteries and she immediately had surgery to correct the problem.

The very thought of heart attacks, one of the most dramatic forms of heart disease, is scary. And heart disease is a major problem for women: it’s our most common cause of death. Roughly 659,000 people in the US die from heart disease each year…that’s 1 in every 4 deaths. That’s a big number. Even during the pandemic, heart disease has beat out COVID. Know the symptoms and don’t ignore them.

Here are some major heart signals that women, in particular, need to know about.

I can’t breathe. While men may have this symptom, women are more likely to have trouble breathing or shortness of breath. This difficulty is usually sudden and may show up for no apparent reason. Don’t wait; go right to the ER.

Chest pain that can move. Pain in the upper body, neck, back, jaw, teeth, shoulder blades and arms (frequently on the left) is another symptom of a heart attack in women. It is called radiating pain because the pain spreads from the point of origin to a larger part of the body. Elephants shouldn’t be sitting on your chest; get yourself checked!

My stomach’s a mess. Women are twice as likely as men to experience indigestion-like symptoms, vomiting, or nausea during a heart attack according to the U.S. Department of Health & Human Services on Women’s Health. Unfortunately, most women tend to dismiss indigestion as a minor problem unless they are also having chest pain. If you’re popping antacids like candy, ask your doctor if there could another issue.

Terribly, terribly tired. About half of women experiencing a heart attack have reported severe fatigue that comes on suddenly, with no apparent cause. A study by The American Heart Association of 515 women who had had heart attacks found that 70.7%   reported fatigue before the event and over half had had trouble sleeping. If you are suddenly losing sleep, or continually tired, it’s time to see what else could be going on.

Cold and clammy. Normal sweat has a cooling effect on your skin. When you are physically active or in extreme heat, your sweat glands can be triggered and you begin to feel cool and clammy.  That’s your body doing what it’s supposed to. But clammy skin that shows up for no apparent reason can be a sign that you’re having a heart attack.

I feel faint. Dizziness or being light-headed is a little-known symptom of heart attacks. Women are much more likely than men to feel dizzy and can faint. Don’t just grab your pearls, get to the doctor for a check-up.

If you think you’re having a heart attack, don’t wait. Go to the hospital and get checked. And once you’re there, don’t be shy, don’t be patient, and if necessary, don’t be polite. Make sure you say, clearly, that you think you’re having a heart attack. That will put medical personnel on notice that your case can’t wait. The medical world tends to treat women with less urgency than it does men, so it’s important to stand up for yourself. Your heart will thank you.