Tara Silvey should have recognized the signs. But despite her emergency first-aid training, she didn’t think “heart attack” as she was having one.

“It was definitely a surprise,” said Silvey, 48, who works as a program resource manager at Monroe Correctional Complex. “I had no lead-up whatsoever, no indicators, no risk factors. And I had never missed a day of work.”

But Oct. 30, she started feeling out of sorts. “I was sitting at my desk and I just felt weird. I told the woman I work with ‘I may not make it very long,’” she recalled.

Silvey decided to check with the prison’s nursing staff. They found her blood pressure to be abnormally high. A few minutes later back in her office, she began to feel dizzy. Silvey remembers constantly rubbing her collarbone, complaining it felt like gas got caught up under her rib cage.

“That’s all classic signs of a heart attack for a woman,” Silvey said. “And I’m cardiac-certified in CPR. You would think I, myself, would have realized what was going on.”

But like many women experiencing cardiac arrest, commonly known as a heart attack, the mother of five didn’t suspect her heart’s vital network of arteries could be out of whack.

Her hectic life was buzzing full speed as usual. And she had no risk factors associated with heart disease: smoking, obesity, family history, diabetes, high blood pressure or high cholesterol.

“I don’t smoke, never have. Do I eat at McDonald’s? Of course. I have french fries once in awhile. And OK, maybe I could stand to lose 20 pounds. But I’m active as can be because I’m chasing my kids all the time.”

After taking only one week off from work, Silvey resumed her busy life. She says she’s a little bit more tired now. But overall, her day-to-day routine hasn’t altered much. Except now, she takes two prescription medications, her kids remind her to not leave the house without nitroglycerin in case of chest pains, and she’s come to terms with having a disease that can’t be cured, only contained, at best.

Spreading the word: Not a “man’s” disease

Heart disease is the No. 1 killer of American women, killing nearly twice as many women than all forms of cancer combined, according to the American Heart Association.

In an effort to recognize half of the population once left out of heart disease research and prevention strategies, educating women on heart disease and heart attack symptoms is the aim of numerous organizations, such as, “Go Red for Women.”

While recognition of the health threat has improved, a knowledge gap persists, surveys show.

In 2012, 56 percent of women identified heart disease as leading cause of death, compared with 30 percent in 1997.

One-in-three Hispanic women are aware that heart disease is their leading killer; only 1-in-8 reported their doctor ever discussed the risk.

Among African-American women ages 20 and older, 48 percent have heart disease but only 14 percent consider it their greatest health problem.

A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. It happens because the arteries supplying the heart with blood have narrowed from a buildup of cholesterol. The blockage can develop slowly over time so its symptoms — feeling more tired, fatigued, short of breath — are often chalked up to simply getting older, getting out of shape and gaining weight.

Women’s heart attack symptoms also tend to be more subtle so they are can easily be mistaken for the flu or acid reflux.

Additionally, women tend to put the health of their family first and might not worry about feeling a bit off.

But here’s why they should: Women are more likely to die of heart disease, also known as coronary artery disease, than men — and have been since 1984. However, cancer, not cardiac concerns is the “c” word women continue to fear most, doctors say.

(One-in-four American women dies of heart disease, 1-in-30 dies of breast cancer, according to the National Institutes of Health.)

“People still think it’s a man’s disease,” says Dr. Gerrie Gardner, a cardiologist with Providence Medical Group, who moved here from Wyoming three years ago. “In Snohomish County, women need to have more education about heart disease. The population are not in tune with their risk for heart disease.”

Gardner, who specializes in women’s cardiac care, says too many of her patients are “astounded” when they experience their first heart attack. “If you feel chest pressure of any sort, think heart pain,” she advises.

Women’s first indication of a heart attack can be upper back pain, Gardner explained, unlike the sudden drop-you-to-your-knees excruciating chest pain experienced by men.

Dr. John A. Elefteriades, chief of cardiothoracic surgery at Yale University School of Medicine and Yale New-Haven Hospital, says women’s lack of awareness about the silent threat of heart disease is one reason he wrote, “Your Heart: An Owner’s Guide” (Prometheus Books, 2007).

“If a woman who just doesn’t feel right, who feels that something is going on with her heart, with her lungs, she should call 911,” Elefteriades advises.

“Women often describe a feeling of fullness rather than squeezing pain on their chest during a heart attack,” he said. “If something like that is going on, make the call. Everybody will be happy if it turns out to be nothing, including the ambulance staff and the emergency department staff.”

It was in the ambulance, when she felt the classic “elephant sitting on my chest” sensation, that Silvey started believing her heart was faltering. She became a true believer after two angioplasty stents were inserted in her arteries during emergency surgery at Providence Regional Medical Center in Everett. “I was having a heart attack the whole time,” she says. “But people who know me still don’t believe me. They say, ‘You had a what? You had a heart attack?’ Sometimes, I still have difficulty believing it.”

Different hearts, different outcomes

Although men and women share risk factors — smoking, obesity, family history, diabetes, high blood pressure and high cholesterol — their fates differ. Women’s heart disease more often goes undiagnosed and untreated and they have more complications during surgery. Doctors also tend to treat a woman with heart disease less aggressively with coronary bypass surgery and stents, and recent studies suggest that females are less often prescribed medication and referred to cardiac rehabilitation.

Additionally, women are more likely than men to die within the first year of a heart attack. Reasons for this disparity range from bias to biology. Typically, following menopause, women are more likely to have heart attacks in their 50s and 60s and beyond; this is believed to be the result a decline in estrogren — which has protective benefits — but the reasons continue to be debated.

Another factor is the historical gender gap of medical research. It wasn’t until the mid-1980s that the National Institutes of Health required women to be included in clinical studies. Research soon revealed women’s hearts and blood capillaries to be generally smaller. That meant that the stents and other devices for angioplasty — a procedure that inserts balloon-like devices into arteries to keep them open once made with only men in mind — needed to be retooled for women’s anatomy.

While medical advances help improve women’s heart disease outcomes, their best defense remains their own behavior, health experts stress.

“Younger women need to learn the risks of heart disease,” Gardner says. “They need to know that women with diabetes and women who smoke are at high risk for heart disease. They need to know their family history.”

More physicians also need to advise women on the dangers of cardiovascular disease, and what can be done to prevent it, she said. “Exercise in all age groups decreases the risk of heart attacks. We know this. But how many of us actually do it?”

Heart smarts for women

Women suffer heart attacks differently than men do. Symptoms are more subtle and include shortness of breath, back or jaw pain, nausea, light headedness.

90 percent of American women have one or more of the risk factors for developing heart disease, which include high blood pressure, diabetes, being overweight, being a smoker (including using nicotine patches), family history and a sedentary lifestyle.

Know your risk factors. Did your parents or grandparents suffer from heart disease, heart attacks, stroke, high blood pressure? Ask your doctor to assess your risks.

Changing behavior, such as adding 30 minutes of daily exercise, reducing fatty foods and controlling your blood pressure can make a difference.

The American Heart Association estimates 670,000 women have been saved from heart disease by making healthier lifestyle choices.

Managing heart disease risk should concern women of all ages:

www.goredforwomen.org/know-your-risk/find-out-your-risk/managing-risk-at-any-age/

Myths &facts

Myth: Heart disease is for men, and cancer is the real threat for women.

Fact: Heart disease is a killer that strikes more women than men, and is more deadly than all forms of cancer combined. While 1-in-31 American women dies from breast cancer each year, heart disease claims the lives of one in three. That’s roughly one death each minute.

Myth: Heart disease is for old people.

Fact: Heart disease affects women of all ages. For younger women, the combination of birth control pills and smoking boosts heart disease risks by 20 percent. And while the risks do increase with age, things like overeating and a sedentary lifestyle can lead to clogged arteries later in life. But even if you lead a completely healthy lifestyle, being born with an underlying heart condition can be a risk factor.

Myth: Heart disease doesn’t affect women who are fit.

Fact: Even if you’re a yoga-loving, marathon-running workout fiend, your risk for heart disease isn’t completely eliminated. Factors like cholesterol, eating habits and smoking can counterbalance your other healthy habits. You can be thin and have high cholesterol.

The American Heart Association recommends you start getting your cholesterol checked at age 20, or earlier, if your family has a history of heart disease. And while you’re at it, be sure to keep an eye on your blood pressure at your next check-up.

Myth: I don’t have any symptoms.

Fact: Sixty-four percent of women who die suddenly of coronary heart disease had no previous symptoms. Because these symptoms vary greatly between men and women, they’re often misunderstood.

Media have conditioned us to believe that the telltale sign of a heart attack is extreme chest pain. But in reality, women are somewhat more likely to experience shortness of breath, nausea/vomiting and back or jaw pain.

Other symptoms women should look out for are dizziness, lightheadedness or fainting, pain in the lower chest or upper abdomen and extreme fatigue.

Myth: Heart disease runs in my family, so there’s nothing I can do about it.

Fact: Although women with a family history of heart disease are at higher risk, there’s plenty you can do to dramatically reduce it. Create an action plan to keep your heart healthy.

Because of healthy choices and knowing the signs, more than 670,000 of women have been saved from heart disease, and 300 fewer are dying per day.

— American Heart Association, Go Red for Women, https://www.goredforwomen.org/