As a healthy and active 34-year-old mother, Jennifer Tucker was pushing her three-year-old son and seven-month-old daughter in the pram one day in 2012.
She did not smoke and had no family history of heart disease. So at her age and fitness, she was not expecting to have a heart attack.
"It's still to this day quite puzzling, to be honest," Ms Tucker said.
Yet that day, she narrowly avoided what doctors said could have been a fatal incident.
She had started struggling to breathe and forced herself to sit in the gutter outside a pizza shop.
The pizza store owner helped her across the road to the GP clinic, but basic tests including an electrocardiogram (ECG) did not reveal anything amiss.
Three weeks later, she visited a cardiologist who recommended an angiogram at a Sydney hospital.
On arrival, the doctor told her she did not need to be there, but that advice quickly changed.
"[The doctor] said, Ms Tucker, you are one of the lucky ones, you have a 90 per cent blockage in one of your major arteries," Ms Tucker told ABC Nightlife.
"If this wasn't caught today, more than likely, this would have been a fatal incident."
An unfortunate misdiagnosis
New South Wales North Coast woman Lynne Bottle was misdiagnosed before later surviving a heart attack.
Ms Bottle, who lives in Pottsville, began to have dull jaw pain two years before the incident.
Her doctor put it down to a recent case of shingles around her eye, she said.
The 66-year-old continued to have the pain until just before New Year's Eve in 2018.
While visiting family in Sydney, the pain suddenly became excruciating and she began vomiting "brown-looking stuff".
"I ran out to the ambulance because it was so bad," Ms Bottle said.
"I got in the ambulance and [the paramedic] said you're having a heart attack. And I said, 'Are you sure?' Because I'd never heard of it happening like that."
Subtler symptoms
Cardiologist Nikki Bart said heart disease in women was regularly being missed.
"We're grossly under diagnosing heart disease in women," Dr Bart said.
"Women are much less likely to present because their symptoms are not what we know as typical."
Dr Bart said for women, a heart attack could appear more subtle.
"Maybe some shortness of breath, fatigue, feeling dizzy, you might have arm pain," Dr Bart said.
"Raising awareness that these subtle symptoms may in fact be a life-threatening blockage, like Ms Tucker had, is really important."
A knowledge gap
Ms Tucker said her doctors had not been able to explain why she ended up in hospital.
"That's not being dismissive of the team at all," she said.
"They did everything they needed to do [and] they gave me all the answers that they could, but it just got presented as a mystery."
Dr Bart said while women made up half of the population, they were often excluded from heart disease research.
This meant incidents in healthy young women such as Ms Tucker often could not be explained.
"Even now, the population of women enrolled in studies is much lower than men," Dr Bart said.
"There's still a lot that we're working out in terms of heart disease and women."
Calls to keep active
Coronary heart disease is the second-biggest cause of death in Australian women.
More than 580,000 Australian adults have experienced heart disease at some point in their lives, according to data from the Australian Institute of Health and Welfare.
To fight the risk of heart disease, Dr Bart recommends 20 minutes of vigorous exercise a day.
"That could be out hiking on undulating hills, or brisk walking," Dr Bart said.
"That significantly reduces your risk of heart disease, but also reduces your risk of high blood pressure, high cholesterol, depression [and] osteoporosis."
For Ms Tucker, the episode got her interested in the Heart Foundation, where she is now a non-executive director.
She also stays physically active to help lower the risk of future heart problems and is an ambassador for Coastrek, a charity hiking challenge for women.
"It's the magic pill of getting out every day and making sure you're walking," Ms Tucker said.
"Putting one step in front of the other really makes a difference to your own heart health."
