Heart disease is the No. 1 killer of women in this country, particularly those over the age of 50. And yet a woman is less likely to take the symptoms seriously, even if she does know what they are, health experts say.

Long before a heart attack brings the issue to a crisis, there are things to be aware of that point to heart disease, which is prevalent in both men and women.

“I do think that women will present later in life because of the estrogen production that they get,” said Dr. Renee Muchnik, of the UPMC Heart and Vascular Institute in North Central Pa.

“Pre-menopause, estrogen kind of protects us a bit from heart disease but then as we lose our estrogen postmenopausal, our rates of heart disease do increase quite a bit, equaling that of men,” she said.

Things to be aware of — tiredness, shortness of breath — might indicate something more serious, but often they are easy to pass off as by-products of a busy life.

“They’ll come to me in my clinic and say, ‘I’ve just been so tired. I don’t have the energy that I used to. I’m more short of breath.’ That’s a very common symptom that kind of gives me a red flag warning regarding the potential for underlying heart disease,” Muchnik said.

When she talks about heart disease, Muchnick noted that she is using it as an umbrella term to describe both heart failure and coronary disease.

Women also tend to spend more time being concerned about others in their families and less concerned with what’s going on with their own bodies.

“Oftentimes, they’re more preoccupied with their own life. You know, they’re always worried about everybody else. And again, since their symptoms tend to be more often atypical, they just chalk them up to, ‘Well, maybe I’m just, you know, feeling under the weather. Maybe I have a cold or maybe it’s because I’m out of shape. Maybe it’s acid reflux.’ So I think that’s why women delay their presentations more so than men,” she explained.

When heart disease leads to a heart attack, women also have some symptoms that differ from men.

“Usually chest pain is still the No. 1 symptom that women will have when they are experiencing a heart attack, but a lot of times women will present atypically,” Muchnik said.

“Sometimes women will just have increased fatigue or nausea, back pain, lightheadedness — those are some of the atypical symptoms,” she said.

Knowing when to go to seek medical help at a family doctor as opposed to going to the Emergency Room for care is also important. The acuity of the symptoms is what determines what type of care is needed.

“If they’re more gradual in onset, I think it can be a simple conversation with your primary care doctor in terms of how to work it up,” Muchnik said.

“But if all of a sudden, you’re experiencing chest pain, and it’s not going away with rest, that is definitely an indication to get yourself to the emergency room ASAP. Also, if you have an episode where you pass out, that’s grounds to go to the emergency room ASAP,” she stressed.

It’s equally important, particularly if there is a history of heart disease in your family, to take proactive measures to minimize the possibility of heart disease or if you just want to maintain your health.

“I always tell all my patients, even if they’re not dealing with heart disease, just, basic things like healthy eating, which is oftentimes for me more of a Mediterranean style diet high in fruits and vegetables, less fried foods. So healthy eating is a very large component of prevention. And exercise — daily aerobic exercise. Sometimes I tell my patients about 30 minutes of aerobic exercise, at least three to four times a week. Those things will be very important,” Muchnik said.

“In addition, just knowing your numbers — knowing what your blood pressure is and knowing what your cholesterol levels are. I’d say once you turn 30, most women should be getting a baseline cholesterol, and maybe even sooner if they have a family history,” she said.

And, just having regular contact with your family physician, not putting off that yearly checkup because you feel good or think you don’t have the time is essential to maintaining your health and catching something before it becomes critical.

“If they would have more regular contact with a physician, then you’d be able to catch things like this quicker,” Muchnik said.