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MIAMI (CBSMiami) — A woman’s heart attack may have different causes and symptoms and some risk factors can be even more dangerous, according to a new, first-ever statement from the American Heart Association.

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Three years ago, Marsha Goodbaum felt nauseous and had stomach pains.  She finally headed to the hospital hours later.

“I had no idea I was having a heart attack. I really expected shoulder pain or heavy chest pain,” said Goodbaum.

A new scientific statement from the American Heart Association says there can be some key differences between men and women when it comes to heart attack symptoms.

“It may not feel like they expect it to feel  but there is usually discomfort somewhere in the chest area, and or in the neck, the jaw, the back, the upper stomach. It can be in either arm or shoulder,” said Dr. Harmony Reynolds with the NYU Langone Medical Center.

This is the first time the association has put out a statement on heart attacks in women, which highlights that women often have different causes of heart attack such as the type of plaque buildup.

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Some risk factors can also be more harmful.

“Diabetes can be twice as strong a risk factor. High blood pressure is a stronger risk factor,” said Dr. Reynolds.

One year later , Goodbaum had the same symptoms and another heart attack. This time she didn’t wait.

“I tell my friends if they have stomach pain, or slight nausea don’t hesitate. I hesitated. I’m glad. I’m alive after that,” said Goodbaum.

She continues to manage her high cholesterol and high blood pressure with medication, diet and exercise.

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The report also says that black and Hispanic women have more risk factors such as diabetes and obesity at the time of their heart attacks.