Why the signs of poor heart health aren’t always obvious

From pain in the left ear to itchiness in the nose, be mindful of ‘atypical’ symptoms

Jeremy Clarkson’s apprehension that something might be seriously amiss was well-founded. The combination of “clamminess”, tightness in the chest together with the sensation of pins and needles in the left arm could scarcely be more typical of angina. He sensibly took himself off to hospital where a coronary angioplasty and stent insertion restored the circulation to his narrowed coronary arteries.
In such circumstances, there’s no difficulty in knowing what’s best to do. But the symptoms of impaired blood flow to the heart muscle can be much subtler. It could be mild discomfort in the chest when walking up a slight incline, for example, or when carrying heavy shopping bags home.
Subtler still is the phenomenon of “atypical angina”. Rather than a feeling of discomfort that radiates across the chest and down the arm, it can be experienced elsewhere. For example, you could have an intermittent pressure like pain in the left ear exacerbated by cold weather, exercise and emotions. More curiously still “atypical angina” can manifest as itchiness of the nose brought on, it is reported, by brisk walking and sexual intercourse.
The thread linking such subtle or “atypical” variations and pointing to a possible cardiac cause is that, on close questioning, the symptoms are clearly related to modest exertion and cease when it is discontinued. This can be confirmed, or excluded, by an exercise test on the treadmill, the pace gradually increases until the onset of symptoms is confirmed by characteristic changes on the electrocardiogram.
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