Differential Diagnosis for PVCs on EKG and Shoulder Pain
- Single Most Likely Diagnosis
- Musculoskeletal strain or costochondritis: This is a common cause of shoulder pain and can be associated with anxiety or stress, which may also contribute to the development of PVCs (premature ventricular contractions) on an EKG.
- Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD): GERD can cause chest pain that radiates to the shoulder and may also trigger PVCs due to esophageal irritation or vagal stimulation.
- Anxiety or stress: Anxiety and stress can cause both shoulder tension leading to pain and cardiac symptoms like PVCs due to the body's fight-or-flight response.
- Mitral valve prolapse: This condition can cause chest pain, palpitations (including PVCs), and may radiate pain to the shoulder due to referred pain.
- Do Not Miss Diagnoses
- Myocardial infarction (MI) or acute coronary syndrome: Although less common, especially in younger individuals, MI can present with atypical symptoms including shoulder pain and may show PVCs on an EKG. Missing this diagnosis can be fatal.
- Pulmonary embolism: This is a life-threatening condition that can cause sudden onset of shoulder pain (if the embolism affects the lung's pleura) and may lead to arrhythmias, including PVCs, due to the strain on the heart.
- Aortic dissection: A severe and life-threatening condition where the inner layer of the aorta tears, which can cause severe shoulder or chest pain and may lead to arrhythmias, including PVCs, due to the involvement of the aortic root.
- Rare Diagnoses
- Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause chest pain that may radiate to the shoulder and can lead to arrhythmias, including PVCs.
- Pneumothorax: Air in the pleural space can cause sudden shoulder pain and, in severe cases, lead to arrhythmias due to the decreased cardiac output and increased stress on the heart.
- Esophageal rupture or perforation: A rare but serious condition that can cause severe chest and shoulder pain and may lead to arrhythmias, including PVCs, due to the severe stress and potential for mediastinitis.