When 58-year-old Rita (not her real name) experienced episodes of gastric pain and chest fullness, she put it down to the effects of ageing and did not give it much thought.
When the problem persisted, she went to see a general practitioner who prescribed her gastric medication.
One night after a bad episode of "gastritis", Rita, who has a family history of heart disease and has high blood pressure, took her gastric medication and went to bed.
She never woke up. She died of a heart attack in her sleep.
Scary as it sounds, many women, especially those in the post menopausal age, have no inkling that they could be suffering from cardiovascular diseases as unlike men, they rarely display the classic symptoms of a heart attack such as chest pain.
Cardiovascular disease (CVD) is now the main cause of medically-certified deaths among Malaysian women, with one in four dying of heart failure.
Deaths from CVD is 21/2 times more common than that of all cancers combined and this has been the trend in Malaysia since 1999.
"Often, the symptoms are very atypical. Very few have the classic chest pain. Instead, they usually come in with shoulder pain or stomach pain which may be mistaken for gastritis. Sometimes they just come feeling tired or short of breath. Because of this, they are often misdiagnosed by healthcare professionals," said cardiologist Dr Jeyamalar Rajadurai.
She said because they often mistook these symptoms for the effects of menopause and because of the lack of the classic heart attack symptoms, women tend to come in with fatal heart failure.
The National Health and Morbidity Survey 2006 revealed that more women die from heart disease than they do from stroke but many are ignorant of this fact.
Dr Jeyamalar, who is the secretary of the Women's Heart Health Organisation, an organisation under the National Heart Association, said a survey that was conducted last year among 5,195 professionals and office workers in Malaysia (71 per cent female) revealed that most were unaware that CVD was the main cause of death for women in Malaysia.
"Some 68 per cent said the main cause was cancer. Only 25 per cent of women were aware that heart disease and stroke occurs in women.
"Some 57 per cent said it never occurs in women and only 14 per cent were aware that CVD can occur even in younger women, that is, before menopause."
She said women tend to have heart diseases about 10 years after menopause although it could also occur before they reach menopause especially among those who were genetically predisposed to the condition.
Menopausal women tend to suddenly put on weight, have increased blood pressure and high sugar levels all of which are risk factors for CVD.
Dr Jeyamalar said women who have symptoms like stomach pain which is associated with sweating or they feel unduly tired or short of breath, especially if they have diabetes or a family history of heart disease, should at least get an ECG done to determine the cause.
"The problem is that a lot of times when it is mild, they think it's nothing. They attribute it to angin (bloatedness and wind), and then they go on and by the time they finally get it, it's already so bad."
Many women, she added, are also in denial and would not make an attempt to get themselves checked even when they know that they could be at risk.
"They think they are superwomen."
She said sometimes financial constraints also prevented these women from seeking treatment. "This is especially so among older women who are dependent on their children to take them to hospital or get their medication for them. So because of that they just keep quiet.
She said because symptoms of a heart attack are vague in women, they should take appropriate preventive steps such as living a healthy lifestyle with a balanced diet and regular exercise.
"And if you have a family history of CVD and are at risk, get your blood pressure, sugar level and cholesterol checked regularly."