More than 1 million Americans suffer a heart attack every year. Traditional symptoms—chest pain or pressure, cold sweat, extreme weakness—are well known. But there are more subtle signs you’re having or are about to have a heart attack that can be easy to miss. If you experience any of the following symptoms, see a doctor. Noticing heart attack signs early and getting prompt treatment can save your life.

1. Fatigue

Dr. Stacey E. Rosen, MD, a Go Red For Women cardiologist at North Shore-LIJ Health System, says this is one of the most common symptoms she sees (especially in women heart attack patients). “In my 25 years of practice, people on the verge of a heart attack report feeling tired and not able to do their usual activities,” she says. During a heart attack, blood flow to the heart is reduced, putting extra stress on the muscle, which could make you feel exhausted, according to WebMD. Don’t be afraid to ask your doctor to do an electrocardiogram (EKG), which checks heart activity. “Sometimes when people present with lethargy, doctors won’t immediately order an EKG, which can detect a heart attack; but you should request one from your doctor, just to be safe,” says Annapoorna Kini, MD, of The Mount Sinai Hospital.

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