Reneta Sikes' left shoulder began to hurt just as her husband pulled up to Target.
"Then it felt hot," she said. Minutes later, in the store's bathroom, sweat poured off of her.
"Just like I jumped into a swimming pool," she said.
Feeling weak, she lay on a bench outside. It was only then that she felt the chest pain most people recognize as a sign of a heart attack.
Mrs. Sikes would have to be revived three times in University Hospital's Emergency Department, but she was around Thursday to tell her story.
Many others are not so lucky.
Women under the age of 50 who suffer a first heart attack are twice as likely to die from it as others, said Nieca Goldberg, the chief of the Women's Heart Program at Lenox Hill Hospital. She spoke to University physicians and later at a dinner launching University's Women's HeartAdvantage Outreach Initiative.
Like Mrs. Sikes' symptoms, theirs may be different from men's: upper back pain, nausea or shortness of breath, Dr. Goldberg said. For that reason, they may put off seeking treatment right away.
"Women get to the hospital on average 12 hours later than men," Dr. Goldberg said, so treatments such as clot busters are no longer an option. "About a third of the women never reach the hospital."
More than 40 percent of women will die from cardiovascular disease - more than all forms of cancer combined - yet few women and even some doctors realize how different and how deadly it is for women, said Augusta cardiologist Kellie V. Lane. After that first heart attack, women are nearly twice as likely to die within the first year as men.
"We have to reduce those second heart attacks that are so very lethal in women," Dr. Lane said.
A key part will be educating women and doctors to recognize the more subtle symptoms and treating women's pain seriously in an emergency setting, Dr. Lane said.
"Any pain above the waist immediately gets an EKG," she said.
Doctors also should address issues such as hormone therapy, which was long thought to help prevent heart disease until the Women's Health Initiative shocked the medical community after its results showed it made it worse, Dr. Goldberg said. Rejecting hormones wholesale, however, doesn't help women suffering from severe symptoms, she said.
"We really need to deal with the quality of life issue," she said.
The bad part for Mrs. Sikes was when she came to after her heart was shocked back into rhythm: She was begging Dr. Lane to save her because she had two small children. The good part is that she and her husband have since stopped smoking, a major risk factor for women and heart disease.
"I feel absolutely I was blessed," she said. "They were not sure I was going to make it."
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.