Surprisingly few people have the classic Hollywood heart attack, the kind that leaves them clutching their chests and staggering.

Chest pain is the most common symptom of a heart attack. Victims typically suffer shortness of breath, jaw pain, arm pain, nausea, and vomiting.

"I didn't fall to my knees"
Kevin Ambrose, 52, of Washington Grove, Md., has had three heart attacks but was never in physical agony. "They were all mild—I didn't fall to my knees," he says. "Instead I got a bad headache or blurred vision." During one heart attack, he recalls, he felt well enough to drive himself to the hospital, even though he knew he should call 911.

Joe Marzan, of Prineville, Ore., who had a heart attack at 31, says he felt his whole chest move with every heartbeat, and then he started vomiting.

It's different for women
In a study of 515 female heart attack survivors, conducted by researchers at the University of Arkansas for Medical Sciences in Little Rock, only 30% described chest pressure before their attack; very few recalled pain before or during their attack.

The most common symptoms in women were unusual fatigue, sleep disturbances, shortness of breath, indigestion, and anxiety. Such "pain-free" attacks, which tend to strike women, people with diabetes, and people over 65, are especially hard to spot.

Linda Rawls, 62, of Boynton Beach, Fla., a veteran of three attacks—the first two of which were overlooked or misdiagnosed at the emergency room—has all but memorized her symptom pattern. "It felt like somebody was squeezing my heart and lungs and everything else in my chest as hard as they could," she says. She felt pressure, but not as much sharp pain as one would expect.

[ pagebreak ]Painless heart attacks can be deadlier
Heart attacks that don't cause chest pain tend to be deadlier than those that do, because they are often misdiagnosed or undertreated. These so-called silent heart attacks may go completely unnoticed unless a patient has an electrocardiogram.

During his last attack Ambrose stopped to make himself a glass of chocolate milk before waking his wife to have her drive him to the hospital, a stall he attributes to dumb denial. "I just thought to myself, 'Oh no, please don't let this be happening again,' " he says.

Whatever your age, health, or gender, it pays to know the basic signs of heart attack—but remember that attacks rarely follow a script.