USICO Healthcare

I was diagnosed with painful (symptomatic) left bundle branch syndrome in August 2023, about 4 months after contracting COVID 19.

After 6 months of steadily worsening symptoms with exercise and at rest (anxiety-related), I develped atrial flutter, and received an ablation during an electrophysiology study – with excellent doctor …very satisfied with the service.

(I have a normal heart MRI, normal ejection fraction, normal EKG at rest)

The symptoms during exercise seem to have improved. This is not to say that the substernal chest pain and shortness of breath have dissapeared, just that the symptoms seem to be improving with exercise. I run 3-4 times per week, and lift weights 4-5 times per week. This improvement with exercise has been documented in studies such as this one:
Exercise Induced Left Bundle Branch Block Treated with Cardiac Rehabilitation: A Case Report and a Review of the Literature.

Also, there have been reports of success in treating painful LBBB (including anxiety-related symptoms at rest) with His-bundle pacing:
Persistent Exertional Chest Pain in a Marathon Runner: Exercise-induced, Painful, Left Bundle Branch Block Syndrome Treated With His-Bundle Pacing.

However, it has also been said in this article, that excercising for Long Covid patients can worsen symptoms.

The article lists lists four hypotheses on that could explain Long COVID’s initiation and progression:

• After a person has COVID, a persistent virus or remnants of it cause chronic inflammation and ongoing symptoms.
• The body’s disease-fighting B and T cells trigger an immune response—and subsequent inflammation—in a process called autoimmunity. The stimulus that triggers this occurs continuously in the body, making it difficult to pinpoint and shut down.
• Latent (or dormant) viruses inside an individual reactivate. (Every person carries multiple viruses that are dormant. Under certain circumstances, they can be reactivated.)
• Chronic changes occur in the body after the acute inflammatory response (COVID infection). Inflammation in one tissue can damage other tissues.

Paxlovid is the primary treatment for COVID, and there is currently a clinical trial investigating whether Paxlovid would be helpful Long Covid sufferers. Sign up for the YALE LISTEN STUDY if you are interested in participating.

The article says we should be careful about exercise:

Exercise may also be beneficial for some patients, she adds. “It’s just a different way of exercising than we’re accustomed to,” she says. While rehabilitation for non-COVID pulmonary patients may involve a push to build muscle and strength, that type of exercise method can worsen symptoms for some Long COVID patients. “So, we have to figure out a way to get them to exercise that targets their needs but isn’t detrimental to them,” she says.

The article explains ‘POST-EXERTIONAL MALAISE (PEM)’.

From article – Not every symptom falls into just one category. A challenging one is what’s called “post-exertional malaise (PEM),” which Dr. McAlpine describes as a kind of “energy crash” or worsening of other symptoms, such as fatigue, brain fog, and muscle pain after exercise—even if the activity was mild. PEM can range in severity. “Some people will walk up the stairs and then not be able to get out of bed for the rest of the day. Others will go on a 10-minute walk or run errands and then be out of commission for a couple of days,” she says.

Physical problems like PEM can lead to anxiety and depression. “It can be a very scary experience,” Dr. McAlpine says. “People feel disoriented, and this can cause new mental health issues. It can be a long road.” In these cases, mental health treatments, such as cognitive behavioral therapy (CBT) and medications, can help, she adds.

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My cardiologist told me at first that beta blockers could be used to handle the symptoms…more recently, he told me he would recommend anxiety medicatons such as Klonopin.

As for me…I would rather not take anxiety medicines…mostly becuase I really do not feel anxious…the symptoms I feel at rest are very disruptive to my life. If they do not subside, I will contact one of the authors of the case studies who report sucess with His-Bundle branch pacing.

Comments welcome!