Even though heart disease is the No. 1 killer of women in the United States, women often chalk up the symptoms to less life-threatening conditions like acid reflux, the flu or normal aging.

“They do this because they are scared and because they put their families first,” says Nieca Goldberg, M.D., medical director for the Joan H. Tisch Center for Women’s Health at NYU’s Langone Medical Center. “There are still many women who are shocked that they could be having a heart attack.”

heart attack strikes someone about every 43 seconds. It occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because the arteries that supply the heart with blood can slowly narrow from a buildup of fat, cholesterol and other substances (plaque)..

Many women think the signs of a heart attack are unmistakable, but in fact they can be subtler and sometimes confusing.

You could feel so short of breath, “as though you ran a marathon, but you haven’t made a move,” Goldberg said.

“Some women experiencing a heart attack describe upper back pressure that feels like squeezing or a rope being tied around them,” Goldberg said. Dizziness, lightheadedness or actually fainting are other symptoms to look for.

“Many women I see take an aspirin if they think they are having a heart attack and never call 9-1-1,” Goldberg said. “But if they think about taking an aspirin for their heart attack, they should also call 9-1-1.”

Heart disease is preventable. Here are Goldberg’s top tips:

  • Schedule an appointment with your healthcare provider to learn your personal risk for heart disease.
  • Quit smoking. Did you know that just one year after you quit, you’ll cut your risk of coronary heart disease by 50 percent?
  • Start an exercise program. Just walking 30 minutes a day can lower your risk for heart attack and stroke.
  • Modify your family’s diet
  • learn smart food substitutions, healthy snacking ideas and better prep methods. For example, with poultry, use the leaner light meat (breasts) instead of the fattier dark meat (legs and thighs), and be sure to remove the skin.