Unusual tiredness and trouble sleeping could be early warning signs of a heart attack in women.
These advance symptoms could be used to help prevent an attack if medical attention is sought and received, according to scientists who studied more than 500 American women.
They said symptoms such as fatigue and sleep disturbance were more common than more obviously alarming experiences such as chest pain and trouble breathing.
Jean McSweeney, the lead researcher, said: "Since women reported experiencing early warning signs more than a month prior to the heart attack, this could allow time to treat these symptoms and to possibly delay or prevent the heart attack."
A total of 515 women - with an average age of 66 - who had been diagnosed with a heart attack were asked about their symptoms before their attack. They were also asked about other health problems and risk factors, such as smoking and being overweight.
A total of 95 per cent of the women said they had new or different symptoms more than a month before their heart attack and that the symptoms stopped after the heart attack. This led them to believe they were linked.
The most common early symptom was unusual fatigue (70 per cent), followed by sleep disturbance (48 per cent), shortness of breath (42 per cent), indigestion (39 per cent) and anxiety (35per cent).
Only 30 per cent said they had chest discomfort before their attack.
"Women need to be educated that the appearance of new symptoms may be associated with heart disease and that they need to seek medical care to determine the cause of the symptoms, especially if they have known cardiovascular risks," Dr McSweeney said.
She said that many women had either ignored the symptoms before their heart attack or the signs were misdiagnosed by doctors.
Dr McSweeney said health professionals needed to be aware of the symptoms which, in conjunction with other risk factors, may help find those women who should have cardiovascular diagnostic tests which could help stop an attack.
The results of the study are reported in Circulation: Journal of the American Heart Association.Reuse content