Nanette Morrow was a busy 36-year-old mother of two and high-profile Pima County prosecutor when the heart attack hit.
It was sudden and very unexpected.
Like many women with heart disease, Morrow did not show typical signs of having a heart attack and was so young that she says even the paramedics who came to her house did not recognize her symptoms.
She did not have high blood pressure and had no strong family history of heart disease. She wasn't a big drinker. Her only real risk was a habit of occasional smoking that began about 10 years ago.
But Morrow is not an anomaly. Heart disease is the top killer of American women. Nine-thousand American women under age 45 have heart attacks every year and a 2007 study by Northwestern University researchers found that cardiovascular disease is on the rise among women in that age group.
Despite the risk, heart disease is not something that women typically think will happen to them, experts say.
Also, women are much less likely than men to seek early treatment for heart-related symptoms.
"Unfortunately, many women don't think that they are at risk for heart disease and still feel that their personal risk of breast cancer is higher than that of a heart attack," said Dr. Brenda Peart, a Tucson cardiologist who also is chief of staff-elect at St. Joseph's Hospital and Medical Center.
"Many women are not aware that one in three women will die from heart disease and only one in 25 die from breast cancer."
Morrow is relieved that she lived to tell her story.
It was the morning of Dec. 23, and Morrow was at home in her pajamas, watching a movie with her daughter. She got up to talk to her mother on the phone, walked outside her house and lit a cigarette. That's when she had her first major symptom: She felt as though someone had just punched her in the chest. Then she felt a burning in both of her arms, like there was acid flowing through her veins.
Morrow's husband was out Christmas shopping and Morrow was reluctant to go to the hospital or call paramedics. She got in the shower, but she was in too much pain.
She woke up her 16-year-old son.
"Call your dad," she remembers saying. "I think I'm having a heart attack."
The 911 operator instructed Morrow to chew on aspirin, which she did, and then paramedics from the Tucson Fire Department arrived. As Morrow remembers it, the paramedics said her symptoms were likely due to acid reflux or early menopause. They said they'd take her to the hospital if she wanted, Morrow said, but suggested she relax and call her doctor in the morning.
That evening, she went to look at Christmas lights. As she walked around she could feel pressure in her chest. Walking into her home that night, "it hit again."
The family called 911 and the paramedics returned.
This time, Morrow's husband insisted they take her to the hospital.
She was admitted and hooked up to a heart monitor. A nurse woke her up about 6 a.m. the next day and told her she was in the middle of a massive heart attack.
Doctors discovered she had three clogged arteries, and one of them was 100 percent blocked.
The doctors could offer only two explanations for her early heart disease: smoking and stress. Women who smoke risk having a heart attack 19 years earlier than nonsmoking women, the National Coalition for Women with Heart Disease says.
Morrow ended up getting three stents in her heart. A stent is a wire metal mesh tube used to hold an artery open. The stent stays in the artery permanently, improves blood flow to the heart muscle, and relieves symptoms.
On Christmas morning Morrow went home from the hospital and stayed home from work for two weeks. She quit smoking cold turkey. She quit her job at the end of February and took a lower-stress position with a downtown law firm that specializes in insurance defense.
She went through an intense cardiac rehabilitation program at St. Joseph's Hospital, and became more vigilant about her diet and exercise.
Peart, the St. Joseph's Hospital cardiologist, says that in general symptoms of a heart attack are more vague in women than in men.
"They may only complain of fatigue or shortness of breath," she said. "Other common symptoms women present with include nausea, weakness, palpitations and chest tightness or chest pressure. Women also tend to attribute their symptoms to getting older, being out of shape or to stress, rather than their heart."
Morrow has advice for anyone who is faced with symptoms of a heart attack: "Be assertive," she urges.