Doctors have become far better educated on the risks of fatal heart attacks in women over the past two decades, and many of them now recognize that warning signs, such as chest pain, may present differently in women than men.

While crushing chest pressure can be a heart attack red flag, women may not have this pressure and instead may feel shortness of breath, pressure or pain in their upper abdomen, dizziness, or fainting, according to the American Heart Association’s website.

But it turns out, these differences don’t help much in enabling doctors to distinguish between a heart attack and other conditions such as heartburn, an infection, or a muscle strain— in either women or men.

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Swiss researchers drew that conclusion in a new study published online Monday in the journal JAMA Internal Medicine after reviewing medical records from nearly 800 women and 1700 men evaluated in European hospital emergency rooms for chest pain indicative of a possible heart attack.

Women having heart attacks were less likely than men to report feeling pain radiating to their right arm and shoulder, the researchers found, and more likely to have pain radiating to their back. Women also tended to have more persistent chest pain that lasted longer than 30 minutes.

But both genders shared a wide array of other chest pain symptoms, and doctors weren’t able to identify the 20 percent of patients having actual heart attacks from those who weren’t; they still needed to perform an electrocardiogram (ECG)—to look at the heart’s electrical activity— and a blood test to measure cardiac troponin, a protein that rises when the heart muscle is damaged, to know for certain.

The new study “clarifies that presentation of chest pain in men and women is not as different as is commonly thought,” wrote McGill University internist Dr. Louise Pilote, in an editorial that accompanied the study. “It provides new knowledge on the value and limitation of chest pain in making a diagnosis [of heart attack] in women as well as in men.”