Andrea Wongsam, 13 weeks pregnant in 2004 with her first child and seemingly healthy, had no idea she was having a heart attack.
The 35-year-old from Kensington, Md., ignored the initial symptoms. Her jaw tightened, and she became so overheated resting in her car that she rolled down her windows and threw off her clothes, even in near-freezing Washington, D.C. temperatures.
But when her left arm went lifeless and the pain became so great, she drove with one hand to an urgent care center. By the time she was airlifted to a hospital, her heart had suffered major damage, and her baby was dying.
Now Wongsam, who is 42 and works in budget and finance at the National Institutes of Health, urges women to educate themselves about heart disease so that they don't face a similar fate.
She will never have children. Her fallopian tubes were tied because doctors didn't believe she could survive another pregnancy because of the heart damage.
"I was in such a dark place," she said of the pregnancy loss. "I felt embarrassed and ashamed and I made poor decisions that killed my kid. It's terrible, and I felt like I needed to help see that other women didn't do as I did."
Wongsam learned about the Go Red for Women campaign and found a "sisterhood" of others whose lives had been shattered by heart disease.
Now, during Heart Month, she and others are telling their stories to educate women about the symptoms that often go unnoticed.
An estimated 400,000 women die every year of heart disease -- 10 times more women than die of breast cancer annually -- and the vast majority of cases are preventable, according to Dr. Susan Bennett, a spokesman for the American Heart Association in Washington, D.C.
"We can control the risk factors and reduce strokes and the need for bypass surgery by 80 percent," she said.
"Women with a family history can have double or triple the risk, depending on whether one or both parents have had the disease," said Bennett.
Women who have had high blood pressure or gestational diabetes during pregnancy are also at higher risk. Other diseases, like lupus, can increase risk, as well as such cancer treatments as chemotherapy and radiation.
Those under 45 years old can have even worse outcomes than older women. "In five years, almost half of them [with heart disease] won't be around," Bennett said.
Women, younger women in particular, often ignore the signs of an impending heart attack, which are often different from the classic male symptoms.
"A lot of time it can be pressure," said Bennett. "There is a tightening or heaviness, but not necessarily pain. Some women stay at home because it's not painful enough to give me a call."
Women are also more apt to report a shortness of breath or a discomfort in the upper back or excessive fatigue.
Wongsam had no family history of heart disease. But she had a bone marrow condition that caused her body to produce too many platelets. A blood clot had formed and caused her heart attack, and she waited a dangerous six hours to get help.
"I thought I was having heartburn associated with my pregnancy," she said. "I just ignored the pain for a while, but then it got worse," she said.
"Having a heart attack was the last thing I ever would have thought of," said Wongsam.
Such was the case with Tami Kemit of Erie, Pa., who was 36 when she had her first heart attack. She had a family history -- but they were men, her father and grandfather.
She wasn't the only one affected. Kemit's daughter Brooke went into cardiac arrest at 27 days old -- she had a congenital heart condition called supraventricular tachycardia, or SVT.
Brooke's condition was brought under control, but on the day of her baptism, Kemit began to feel fatigued, as if she were coming down with the flu. By the time she saw the doctor and was put on a monitor, she learned she had been having a heart attack for three days.
"I had felt really tired and sick to my stomach," said Kemit. "I couldn't do anything and I slept most the day … I had no chest pain."
Kemit had congestive heart failure, angina and blockages in two arteries and her heart had been severely damaged. Since then, she has had four more heart attacks and had to give up her up her job as a hairdresser.
"I couldn't breathe and walk at the same time," she said.
During her second heart attack, she felt pressure spreading down her arm. With her third attack, it was jaw pain, and her fourth was identified by pain in her shoulder.
Since June 16, 2000, Kemit has had multiple angioplasty procedures, triple-bypass surgery and a pacemaker and defibrillator implanted.
"People don't understand it's the number one killer of men and women and children, not cancer," said Kemit.
"If anybody in the family -- man under 60 or woman under 30 -- has had a heart attack, you need to stress to your doctors to check it out and -- cholesterol and blood pressure -- and stay physically active."
If a doctor dismisses complaints about heart symptoms as "just in your mind," said Kemit, "you need to move on. ... Go with your instincts even if they say you are crazy."
Risks can be modified by quitting smoking, keeping a healthy diet and watching cholesterol, as well as getting medical attention for high blood pressure and diabetes, according to the American Heart Association.
"Weight ends up being the cornerstone of other risk factors," according to cardiologist Bennett.
Risk of cardiac disease increases with age and even though it affects men in greater numbers in their 60s and 70s, more women in their 80s are heart attack victims, she said.
Under the new health care law, there is hope for women with heart disease, many of whom have been previously denied insurance because of a pre-existing condition.
"This is very important," said Bennett. "Women have been denied in the past. Now they have also eliminated co-pays for important screenings of cholesterol and blood pressure."
She is also hopeful the Heart for Women Act, which is now in Congress, will be passed.
"It's a very important act and will mandate the FDA to analyze new drugs by gender," she said. "What works for a 56-year-old white male may not work for a 56-year-old female going through menopause."
As for Wongsam, she has made dramatic changes in her life since experiencing a heart attack in 2004. She exercises, chooses healthier foods and has participated in fitness boot camps. She even organized her own team for an American Heart Association Heart Walk.
After the loss of her baby, her life came to a standstill. She was overcome by fear and anxiety, but now she is committed to helping others.
"I Go Red for all the women out there that live with heart disease, including myself."
To evaluate your risk for heart disease, go to the American Heart Association's My Life Check tool that gives a "heart score" to let consumers know where they stand on the road to good health. It also offers an action plan for improvement.