You're a woman and you have a pain in your back that settles between your shoulder blades. You're also tired.

Or maybe you're having stomach pain and you're nauseous.You might be thinking you pulled a muscle or that you caught a bug.You're probably not thinking heart attack."I always thought a heart attack was when you grab your chest and fall to the floor," says Kim Guerra, "but it's not."Guerra was taking a shower one evening a few days before Christmas in 2013. Her chest started to hurt "a little bit," and she was having a hard time breathing. She finished her shower, stepped out and sat down."I thought it was anxiety," says Guerra, 49, who lives in Albrightsville with her husband, Michael, and son Richard, 14. "Or gas, or something like that."She called a friend whose husband is a firefighter and a first responder."They came over and he gave me a bunch of low-dose aspirin. Then I started getting pain in the center of my back."Something wasn't right, but Guerra wasn't thinking heart attack."It was uncomfortable enough for me to say 'Something's not right,' but it wasn't debilitating," said Guerra."It wasn't bad at all. The heartbeat was going fast, and my chest was pounding. That was the thing that really concerned me."When the aspirin didn't help with the pain, Guerra's friend drove her to the emergency room."When I told them about the chest pains, they took me in and did an EKG (electrocardiogram) and gave me blood thinners."While an EKG didn't show she was having a heart attack, her blood tests showed her troponin levels were high.Troponin is a protein that is released when there is damage to the heart muscle. If a heart attack is suspected, blood work is repeated three times three hours apart to check for cardiac enzymes and proteins.When Guerra's second blood draw showed her troponin levels were climbing, the ER began treatment and she was admitted to the hospital. By the third blood test, troponin levels were dropping."I kept asking the doctor: A heart attack? I couldn't believe it because of my age," says Guerra, who was 46 at the time."My health was normal. I wasn't an exercise freak, but I did yoga and more relaxing exercises, not cardio or anything like that."She admits that her weight was higher than it should have been and was above what her normal weight should be, but she wasn't what she would describe as "fat."A cardiac catheterization indicated there was damage to Guerra's heart, but not enough to warrant a stent, which is a tubelike device placed in the coronary arteries that supply blood to the heart.She was prescribed blood thinners, as well as high cholesterol and high blood pressure medication.Guerra was also instructed to take low-dose aspirin daily, and was given nitroglycerin, which opens the blood vessels to improve blood flow, to take in the event of chest pain.Difficult to diagnoseMartine Bannon-Ford's symptoms were so unusual, it took two weeks before she learned she'd had a heart attack.In early March of 2015, Bannon-Ford, 45, woke up on a Monday with pain under her upper left arm, pain where her ribs meet in her chest, nausea and diarrhea.Although the pain in her arm was gone the next day, by Friday, she wasn't much better, so she went to the doctor."He told me he thought I had a bowel obstruction," Bannon-Ford says.A CT scan with contrast ruled out an obstruction, and the Lehighton woman was sent home with medication for nausea and diarrhea.She asked if her kidneys, liver, gall bladder, lungs and heart were OK, and was told that, yes, everything was fine."I went home. I thought it was bronchitis, only I wasn't coughing."A week later, she still had the pain in her lower chest."The other symptoms were gone, but now I had a new symptom. I was breathing fine, but I didn't feel like I was getting enough air."She went back to the doctor's office. This time she saw a different doctor in the practice. He suggested they run an EKG.The nurse came in, performed the EKG and left the room. The doctor rushed in and told Bannon-Ford that she had either had, or was having, a heart attack."He saved my life. Nobody else thought to run an EKG," she says."Mentally, I was terrified I was going to die. Absolutely terrified."She was admitted to the hospital, where she was given blood thinners, aspirin, medication for high blood pressure and high cholesterol, as well as a nicotine patch.Bannon-Ford underwent cardiac catheterization, but unlike Guerra, she did need a stent inserted in one of her arteries."I went into the hospital on a Friday. The procedure was Sunday. I was released on Monday."Causes varyGuerra says her heart attack could be linked to stress and genetics.Her main stressors were lifestyle, work and "just normal stuff, finances and things like that."Genetically, her paternal grandmother had a massive coronary at 86, but says it would be more expected at that age.Bannon-Ford's genetic history is concerning, but didn't most likely didn't contribute to her heart attack.Her paternal grandfather and grandmother both died following heart attacks.Her father had his first open heart bypass surgery at 47 and died from complications of multiple heart attacks when he was 61. And a maternal uncle died recently after a massive heart attack at the age of 66.Her cardiologist "said I had normal plaque buildup for a 40-year-old person, but what happened was a piece of plaque peeled away and blocked the artery. It just happened."He told her it wasn't from smoking. She's not overweight. Her cholesterol was a little high. Her blood pressure was high, but not critical, and she was already on medication for her blood pressure.She had been having episodes of arrhythmia and palpitations, but the results of a 48-hour Holter monitor test showed nothing, and a stress test was also negative."They said my heart looked great," says Bannon-Ford.Six months later she had a heart attack.Positive changesAfter her heart attack, Guerra lost 50 pounds, but admits she's since gained some of it back. She's no longer on blood thinners or high blood pressure medication.She continues to do yoga, but also does cardio exercises twice a week. Her diet has changed as well."Before, I had my healthy food, but I also had a lot of junk food - cookies, ice cream, little fruit snack packages," says Guerra."After the heart attack, I cut out the junk and I started eating more fruit. There's more fish in my diet, too."Guerra never ate a lot of red meat, but she's now eating more fish and chicken."I feel pretty good," Guerra says. "I still have some chest pains once in a while."She attributes those pains to gas pockets."If I move around, it dissipates."In the beginning, she'd called the doctor every time she had chest pain."I'd call and they told me to take the nitro, and if the pain goes away, you're fine. If it doesn't then I have to go back to the emergency room."She only had to make the trip once, two months after her initial heart attack, and it turned out she was fine."Paranoia," she says.Bannon-Ford still smokes, but says she's down to about 10 cigarettes a day and is trying to quit.The recently separated mother of three says quitting has been difficult, especially after having smoked for 30 years.She is also more active now, and does a lot of walking."I've always eaten healthy, but I cut out a lot of snacks. I get more sleep, too. That's actually very important."Meanwhile, she continues to have some concerns, and due to ongoing arrhythmia/palpitations, she recently had to wear a Holter monitor for 24 hours to record her heart's activity and determine if her heartbeat is irregular and if more tests are necessary.Advice for other women"If you're having symptoms, make sure you get it checked out and get to the ER because you just don't know," says Guerra."There really wasn't much pain."Bannon-Ford also says women need to think of themselves more."I'm one of those people who doesn't like going to the doctor. I put it off as long as I can," says Bannon-Ford."But now I know, I need to go and get checked out. I don't want to die. I'm young. I have children. When you have kids and they get sick, you take them to the doctor. When you get sick yourself, you're like, I'll wait. I'll get better."Make sure to check out next Tuesday's Health page for more about women's heart health and our interview with Steve Albrich, a physician assistant in the emergency room at Blue Mountain Health System.