On the morning of December 15, 2016, 37-year-old Christine Wayne woke up feeling tired and more rundown than usual. Although she had a cold that week, she thought she should feel better.

The Stamford, Connecticut, woman stayed home from work and rested, but decided to keep her dinner plans with a friend even though she didn’t feel right.

“Suck it up. You can figure this out, it’ll be fine,” she told herself.

While taking a shower, she suddenly had a cough that felt odd to her.

“It felt less like a surface-level cough—it felt deeper,” she said. “From there, everything was very slow motion. I was so tired with every movement. It was exhausting.”

Wayne stepped out of the shower, felt lightheaded and then vomited. She knew something wasn’t right, but she didn’t know what to do.

She thought about calling 9-1-1, but she worried about causing a scene in her apartment building and wondered how much the co-pay for the ambulance would be. She thought maybe it was anxiety or something was wrong with her lungs.

“Not once did I think heart attack,” Wayne said.

She ended up calling 9-1-1 and paramedics took her to the hospital. When she arrived, Wayne said she started to feel hot.

“That’s when my memory stopped and that’s when my heart stopped for the first time,” she said.

In the hospital, a team of doctors desperately tried to resuscitate her but her heart stopped again.

“Between 7:04 and 7:20 [p.m.], they didn’t know if I was going to make it,” she said.

Not only did Wayne suffer a heart attack, but she went into cardiac arrest four times. Doctors put two stents in her heart to open up a blocked artery and she remained in the hospital for eight days as family and friends gathered around her, praying and wishing her a speedy recovery.

“I’ve always thought about [a heart attack] as something way off in the future—as something that would happen to my parents, not me,” she said.

Why do young women get heart disease?

Heart disease is the number one killer among women and in recent years, there has been more awareness around the issue, especially with initiatives like Go Red For Women.

Coronary heart disease is often seen as something that affects middle-age or older women, yet more young women than ever before are at risk and they have no idea, experts say.

“Heart disease is not even on the radar screen of young women,” said Dr. Holly S. Andersen, a cardiologist in New York City and director of education and outreach for the Ronald O. Perelman Heart Institute and Scientific Advisor for the Women’s Heart Alliance.

Andersen said that in women between ages 29 and 45, both heart disease and stroke are on the rise.

Although it’s not clear why there has been an uptick, experts say it likely has a lot to do with the fact that risk factors such as obesity, high blood pressure and type 2 diabetes are also increasing.

Most people with obesity also have insulin resistance, a syndrome that leads to pre-diabetes, diabetes and coronary heart disease, said Dr. Steven R. Gundry, a cardiologist in Palm Springs, California.

Not surprisingly, an unhealthy diet plays a role, especially one that includes too much meat, sugar and processed, packaged foods.

Antibiotics found in meat, pesticides and gluten all alter the body’s microbiome and healthy gut bacteria and in turn can lead to heart disease. In fact, there is a clear link between environmental toxins such as dioxins, PCBs, and pesticides to atherosclerosis, according to a 2011 study out of Sweden.

“Women have been taught that estrogen protects them from heart disease, but that’s just simply not the case anymore,” Gundry said.

Stress may also play a role in heart disease risk and millennials, Generation Xers and women are the most stressed, according to a survey by the American Psychological Association.

Pregnancy and childbirth also put a lot of stress on the body, because women have extra blood volume and a higher risk for blood clots.

Another condition that’s common in the postpartum period and happens almost exclusively in women is spontaneous coronary artery dissection (SCAD), which causes an artery to tear and can lead to a heart attack, Andersen said.

Women who have high blood pressure during pregnancy, gestational diabetes or preeclampsia, are all at an increased risk for cardiovascular disease later in life.

Know the signs.

The symptoms of a heart attack often look different in women than in men.

Although women often experience chest pain, 40 percent of those who have a heart attack do not. Pain in the back, arm or jaw can also be signs.

Women may also have shortness of breath, indigestion, sweating, experience an overwhelming sense of doom or simply feel different.

“Most women know that something is wrong,” Andersen said.

Since most women are used to putting everyone else before themselves, they may brush off their symptoms as something else, neglect to call their doctors or go to the emergency room.

“All too often…women don’t call 9-1-1, they don’t act. And they often have more damage than they should or they die,” Andersen said. “Even women who believe they’re having heart attacks are not as likely to act and that’s a mistake.”

What women need to know

Experts agree that when it comes to heart disease, prevention is key because “80 percent of this disease is preventable,” Andersen said.

All women should keep track of their family histories and talk to their doctors about their risk for a heart attack. Screening tools like the coronary calcium scan and the carotid intima media thickness (CIMT) test are available, although they’re not covered by insurance.

Of course, a healthy diet, regular exercise, sleep and stress reduction are all important too.

e future is still unknown. Her doctors are currently trying to find out why she had a heart attack, especially because she doesn’t have any of the traditional risk factors.

As she continues her journey to optimal health, Wayne is committed to raising awareness about heart disease in young women. She wants to motivate women to put their health first and avoid talking themselves out of how they feel, even when they know in their gut something is wrong.

“It’s ok to call 9-1-1,” Wayne said. “If I didn’t, I would have died in my apartment.”