In the movies, it's easy to figure out who will have a heart attack (the old, overweight guy with the high blood pressure and high cholesterol readings) and how it's going to feel (excruciating chest pain and shortness of breath). In real life, causes, heart attack and heart disease aren't always as easy to discern.

As local cardiologist Dr. William Dang Jr. notes, much of what we think we know about heart problems can be incomplete, misleading or simply false.

Dang is a volunteer with the American Heart Association, which is gearing up for its 30th annual Heart Ball fundraiser in February.

According to Dang, high blood pressure, high cholesterol, diabetes and family history are the most common risk factors for heart disease. Other factors include obesity and a sedentary lifestyle.

In an increasingly health conscious (but not necessarily healthier) society, this is fairly common knowledge. But common knowledge can sometimes foster unfounded complacency — and that's where the danger lies. "There are so many different factors," Dang says. "You may have one or two but not the others, and think that you aren't at risk."

MYTH: My blood pressure/cholesterol is OK, so I'm OK. As Dang notes, people who have normal blood pressure or cholesterol readings shouldn't assume they don't have or can't get heart disease.

This biggest misconception, he says, is the notion that, "It won't happen to me; it always happens to someone else."

MYTH: Women don't have heart attacks. Heart-related ailments are the leading killer of women, accounting for more deaths than all other diseases combined, Dang said.

Estrogen can have a limited heart-protective effect for women, but this benefit fades away as estrogen levels decrease after menopause.

MYTH: Young people aren't at risk. The conditions that lead to heart problems do tend to accumulate or worsen with age. However, Dang said he has treated patients in their 20s and 30s. One cause of heart attack in younger people is the use of drugs like crystal methamphetamine and cocaine, which Dang said can cause massive heart attacks in young users.

MYTH: Only chest pains warn of a heart attack. Dang said some people do not know when they are experiencing a heart attack because they do not experience chest pain. In fact, only a third of heart attack patients report feeling chest pain. Many report no symptoms at all. People with diabetes, for example, may not feel chest pain because of decreased nerve sensitivity.

MYTH: A stress test will give an ironclad diagnosis. There are myriad diagnostic tests available, from the standard EKG stress test, which observes symptoms, to nuclear scans, which examine blood flow. Each is effective to varying degrees, but might miss any one individual's heart attack symptoms.

Dang said that most studies involving stress tests were done 20 to 30 years ago using male subjects, and those tests may not be as accurate for women.

The angiogram, also called heart catherization, is the "gold standard" of heart diagnostic tests in Dang's view. In this test, small catheters are used to inject dye into the coronary arteries, making it possible for doctors to look for narrowed or blocked arteries on a monitor.

Once diagnosed, there are various means of treating heart diseases and its causes, with varying levels of effectiveness.

For example, an angioplasty, in which a small balloon is used to open blocked blood vessels, is an effective short-term solution, but unless the causes for the plaque buildup are addressed, the blockage will likely return.

Dang says the best long-term solutions are the most obvious: Lose excess weight, limit fat and cholesterol intake, and exercise. If necessary, medications to lower cholesterol levels and blood pressure are also effective.

"It's never too late," Dang says. "You can always do better."

Reach Michael Tsai at mtsai@honoluluadvertiser.com.