Dr. Kaustubh Dabhadkar, a Charlotte, North Carolina-based cardiologist specializing in preventive cardiology, has issued a warning about atypical symptoms that may indicate serious heart issues. Common queries from his patients focus on symptoms to monitor. While typical heart-related symptoms, like chest pressure that extends to the arm or jaw, are straightforward, atypical ones are harder to diagnose.
The Challenge of Atypical Symptoms
A study published in 2025 in the Journal of the American College of Cardiology shows over 99% of people with coronary artery disease, heart failure, or stroke had at least one risk factor before diagnosis. Risk factors include high blood pressure, high cholesterol, elevated blood sugar, and smoking history.
Dr. Dabhadkar recalls a significant experience during his cardiology fellowship, advising physicians to recognize unusual symptoms as potential heart issues. He shares an anecdote about diagnosing a heart attack in a patient with an ‘earache’ revealed by an EKG.
Recognizing Unusual Symptoms
An EKG, or electrocardiogram, assesses a patient’s heartbeat by recording heart electrical signals, aiding in diagnosing heart attacks or irregular heartbeats. In this case, the EKG showed a major artery was failing, causing pain localized to the patient’s ear lobe.
“We opened the artery. The ear stopped hurting.”
Dr. Dabhadkar emphasized that unusual symptoms are due to referred pain, where heart nerves intersect with the spinal junctions for the chest, shoulders, arms, neck, jaw, and upper belly. The brain receives a signal and may misinterpret the source.
Identifying Heart Attack Symptoms
Dabhadkar mentions symptoms of a heart attack can be unexpected, such as cold sweats not alleviated by cooling air. People often rationalize their symptoms with simple explanations, delaying evaluation. Around a third of heart attack patients experience no chest pain. For those over 65, chest pain becomes less common, affecting diagnosis.
Potentially overlooked symptoms include pain in the jaw, teeth, throat, upper back, or unexplained breathlessness and fatigue after exertion.
New, unexplained, effort-induced symptoms that ease with rest deserve scrutiny: persistent cold sweat, nausea, or an intense sense of distress warranting further investigation with an EKG.
“I would rather see a hundred false alarms than miss one real heart attack.”
This approach emphasizes the importance of not dismissing unusual symptoms and remaining vigilant for varying heart attack signs.

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