Still think heart disease is a guy thing? Think again. Some 8 million women in the United States have heart disease, and each year an estimated 435,000 women suffer a  heart attack, according to the Women’s Heart Foundation. So yes, a heart attack can happen to you. But would you recognize the symptoms if it did?

A woman may or may not have the classic symptom of a heart attack — crushing pain that feels like an elephant sitting on your chest. Often, there’s no chest pain at all, but more subtle symptoms that women, and even doctors, tend to overlook.

Why should you learn the symptoms of a heart attack? Because 90 percent of women have one or more heart disease risk factors.

Related: 10 Health Symptoms Women Should Never Ignore

Here are six warning signs that can spell trouble.

1. Vague discomfort in the upper body. A common heart attack symptom for women is pain and pressure in the chest, similar to indigestion. It can travel from the chest to the upper back, shoulders, neck, jaw or arm. But if it’s our heart that’s being “attacked,” then why are we feeling pain in other places? “The heart has no direct pain fibers,” explains Richard Krasuski, MD, a Cleveland Clinic cardiologist. “So when the heart is being damaged, the sensation of pain has to hitch a ride on other nerves in the area. We describe this as referred pain.”

2. Shortness of breath. A survey of female heart attack survivors found that during their heart attack, or sometimes even in the days or weeks before, almost 58 percent of the women said they felt short of breath, in some instances making it difficult to carry on a conversation. If you’re feeling particularly winded without doing much, go to the ER, says Amy Doneen, DNP, ARNP, medical director of The Heart Attack & Stroke Prevention Center in Spokane, Washington.

3. Anxiety. Don’t be so quick to blame your hormones or hectic lifestyle for your anxious feelings. Many women experience a sense of impending doom or fear before a heart attack. An abnormal heart rhythm is often the cause of anxiety when heart disease is a factor according to the National Institutes of Health. Let your doctor know if you experience anxiety so he or she can look into the root cause.

4. Sweating profusely. Hot flashes from menopause can leave you dripping in sweat, but so can an impending heart attack, warns Doneen. If you’re sweating intensely and your skin is pale, get to the ER.

Related: Is It Menopause or Low Thyroid? 

5. Dizziness or nausea. Women often feel like they’re going to pass out or throw up during a heart attack due to decreased blood flow to the brain. Pay attention to these symptoms, especially when they’re combined with shortness of breath, a cold sweat, rapid headache and blurry vision.

6. Unusual fatigue. More than 70 percent of women reported extreme fatigue and flu-like symptoms in the month or months prior to their heart attacks. If you feel like you have zero energy, to the point where it’s difficult to get out of bed and go about your day, get yourself checked out. Extreme fatigue might mean your heart isn’t pumping enough blood.

Know your family heart health history: It might just save your life

A family history of heart attack or stroke increases your risk. If your mother or father had early heart disease, including heart attack in men before 55, women before 65, your heart disease risk is two to nine times higher than average.

If there’s a history of either heart attack or stroke in your family — or of diabetes, vascular dementia, Alzheimer’s disease, peripheral vascular disease or kidney disease — see your doctor for a heart health screening as early as your twenties, says Doneen.

Related: Warning You Could Have Diabetes and Not Know It

“Periodontal disease, tooth decay, psoriasis, rheumatoid arthritis and pre-diabetes can also increase your risk of heart attack,” says Doneen. So be sure these health conditions get addressed — and make it on to your medical chart.

Think you’re having a heart attack?

If you think you're having a heart attack, never second-guess yourself. A good rule of thumb: “If you feel differently than you ever have before, consider the possibility that it might be your heart,” says Doneen. Take slow, deep breaths, call  9-1-1, take an aspirin and go to the emergency room. “Do not drive yourself,” she stresses." Just get to the hospital, get assessed and don’t wait politely in the waiting room – get attention!”

Your odds of surviving a heart attack improve by 23 percent if you get treatment within three hours, and go up to 50 percent if you are treated within one hour.

Tara Rummell Berson is a health and wellness writer and editor. Her work has been featured in numerous media outlets, including Redbook, WebMD and The Huffington Post.