Garvey, A 55-year-old Kailua-based business consultant, went from the emergency room at The Queen's Medical Center to quadruple bypass surgery that afternoon.

"All of the doctors agree that had I gone to Kaua'i, I would be dead," she said.

While Garvey's story is more dramatic than most, specialists say many women don't suffer the typical chest-clutching and swooning attack seen in movies and on TV shows.

More often, the signs are more subtle: chest discomfort, breathlessness, a feeling of being tired. But the danger is real. Heart disease kills more than 1,000 Hawai'i women each year and accounts for more than one in four of all deaths among women, according to the American Heart Association.

"We know that 10 times as many women die from cardiovascular disease, which includes heart disease and stroke, than from breast cancer," said Dr. Joana Magno, a cardiologist.

Women are at risk in various ways. Many smoke. Others are overweight. Some have diabetes, or high blood pressure or high cholesterol.

Magno said the always-on-the-go multitasking lifestyle of women takes a toll. Women are wives and mothers who are also pouring energy into their careers.

"Women are in a tough spot these days," Magno said. "You give and give and give of yourself. We have to be incredibly good at being time managers."

She's troubled by evidence that women who care for others leave themselves last on the list and ignore warning signs that can save their lives. She said women need to be more aggressive in getting care for themselves.

Garvey said she felt no chest pain, no shortness of breath and no dizziness.

"My arms felt very heavy," Garvey said. "Right as the plane was boarding, I decided not to go."

Garvey had to use both hands to carry her briefcase back through the terminal, but still she had no idea what was wrong. "I didn't think I was having a heart attack. I just felt really weird."

It has been three months since Garvey's heart attack, and her lifestyle habits are improving with the help of her husband and her business partner, Brook Gramann, who helps her keep on track by walking with Garvey and critiquing her food choices.

"I'm eating less and exercising a lot more," Garvey said. "I feel completely well."

Magno said more women would live longer and healthier lives if they paid more attention to their health and responded quickly. "Women delay in getting help. Women don't call 911," Magno said. "They may feel (like) junk, but they'll get the laundry done first."

Waiting too long can be fatal, she said.

Magno encourages women to realize that small steps work: getting more physically active by taking the stairs at work, cutting out fatty foods, eating more fruits and vegetables.

"You can't expect instant gratification," Magno said. "You have to be sensible about doing all these things."

She said all those making lifestyle changes should give themselves six months or a year to see the changes.

Magno said patients need to be more aware of the different ways that heart disease can show up. And some attitudes in the medical community need to change as well.

She said a doctor told one of her patients that she needed to be on tranquilizers: "It's not your heart; it's anxiety."

The woman needed bypass surgery the next year.

So, she reminds all her patients to watch for breathlessness, a feeling of being tired, especially unexplained fatigue.

It's been 18 years since 'Aiea resident Amy Tsuhako noticed some shortness of breath and a pain in her rib cage. When she knelt down to do yard work, "I would see stars."

But she was fit, 5-feet-2, 118 pounds, running regularly in organized events and eating reasonably well. Nothing to indicate she could have heart trouble.

"Nothing was going against me but my symptoms," Tsuhako said. But she insisted to her doctors that she needed tests. "I knew my body and I really listened to my body," she said.

When she finally underwent those tests, the doctors rushed her from one evaluation into surgery. "The doctor said that I would not even have time to get a second opinion." She had a double bypass and has kept fit since then with the help of continued exercise, improved diet and the unwavering support of her husband, Keiji.

Tsuhako, 67, walks at least twice a week, does yoga twice a week and aerobics weekly. Her husband works out right alongside her. "I think I'm successful because of my husband being so supportive. He's always there for me," she said.

And Tsuhako credits yoga classes for keeping her flexible and fit. "Yoga teaches you balance," which she finds more important as she ages. "My muscles are so much better now."

She also relies on friends and her four sons, eats lots of fish and chicken, fruits and veggies. "We totally stay away from all fast food," she said.

"It was a shocker to know you still have heart trouble even after taking care of your health," she said.

Garvey agrees and said the experience made her realize that she should have been more aware of her health, not just for her own sake, but also for those closest to her: her husband, her business partner, Brook; her 25-year-old son and her five stepchildren. "If I had died, a whole lot of people would have suffered terribly."

She urges women to pay more attention. "I probably knew there was something wrong. But I was avoiding it. I didn't want to think about it," she said.

"I was very lucky."