How can anxiety exacerbate symptomatic LBBB (Left bundle branch block)?

Anxiety can exacerbate Left Bundle Branch Block (LBBB) by increasing the overall sympathetic nervous system activity, which can affect the heart’s electrical conduction system. Here’s how anxiety might worsen LBBB symptoms or its underlying condition:

1. Increased Heart Rate (Tachycardia)

• Anxiety triggers the “fight or flight” response, releasing stress hormones like adrenaline. This can lead to an increased heart rate, which places additional strain on the heart.
• In the presence of LBBB, where electrical conduction is already delayed through the left side of the heart, a rapid heart rate can worsen the incoordinated contraction between the left and right ventricles, potentially increasing the risk of arrhythmias or other heart-related symptoms.

2. Increased Sympathetic Nervous System Activity

• Anxiety causes heightened sympathetic nervous system activation, which can raise blood pressure and cause vasoconstriction. This can increase the workload on the heart, especially in someone with LBBB, where the electrical signals are already disrupted.
• The heart may struggle to synchronize its contractions, which could worsen feelings of palpitations, dizziness, or shortness of breath.

3. Hyperventilation

• Anxiety can lead to hyperventilation, which decreases carbon dioxide levels in the blood, causing alkalosis (an increased pH in the blood). This shift in pH can make the heart more prone to arrhythmias and disrupt the normal electrical conduction, including in people with LBBB.

4. Stress on the Heart

• Chronic or intense anxiety can contribute to increased stress on the heart, leading to increased workload and possible myocardial ischemia (reduced blood flow to the heart). This might make someone with LBBB more susceptible to episodes of chest pain, fatigue, or fainting (syncope).

5. Worsened Symptoms

• For someone with LBBB, anxiety can trigger or amplify symptoms such as chest tightness, shortness of breath, or palpitations. These symptoms may overlap with or even mimic heart-related problems, leading to a sense of worsening heart health, which then increases anxiety, creating a vicious cycle.

Managing Anxiety and LBBB

• Relaxation techniques like deep breathing, meditation, and mindfulness can help manage anxiety and reduce its impact on heart function.
• Regular exercise (as permitted by a healthcare provider) can improve overall cardiovascular health and help mitigate anxiety.
• Cognitive-behavioral therapy (CBT) or other psychological interventions can help address chronic anxiety, which could have a positive effect on overall heart health.

If you notice that anxiety is making your LBBB symptoms worse, it would be beneficial to speak with your doctor about both managing your anxiety and addressing LBBB symptoms together.