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Effects of transcendental meditation on symptoms and electrocardiographic changes in patients with cardiac syndrome X

      The term cardiac syndrome X is applied to patients with anginal chest pain, positive response to exercise stress testing, and normal coronary angiograms. Such patients have a good prognosis regarding survival and acute coronary events but often remain symptomatic despite conventional antianginal medications and the reassurance provided by the cardiologist.
      • Kaski J.C.
      • Rosano G.M.
      • Collins P.
      • Nihoyannopoulos P.
      • Maseri A.
      • Poole-Wilson P.A.
      Cardiac syndrome X clinical characteristics and left ventricular function. Long-term follow-up study.
      The chest pain that they experience is often exertional but frequently also occurs at rest. Such symptoms may mimic unstable angina and lead to readmission to the hospital and repeat investigations. Cardiac syndrome X is costly to the health service and also has considerable adverse effects on the patient’s quality of life, self-esteem, interpersonal relations, and employment.
      • Kaski J.C.
      • Rosano G.M.
      • Collins P.
      • Nihoyannopoulos P.
      • Maseri A.
      • Poole-Wilson P.A.
      Cardiac syndrome X clinical characteristics and left ventricular function. Long-term follow-up study.
      Cardiac syndrome X probably encompasses multiple pathogenic mechanisms. Among these, psychological abnormalities, particularly anxiety disorders, have been identified.
      • Potts S.G.
      • Bass C.
      Chest pain with normal coronary arteries psychological aspects.
      These abnormalities are not a transient reaction to the medical condition but are persistent, increase over time, and predict chest pain many years later. Anxiety may contribute to the evolution of chest pain through different mechanisms.
      • Potts S.G.
      • Bass C.
      Chest pain with normal coronary arteries psychological aspects.
      There is evidence that autonomic imbalance with persisting sympathetic stimulation is present in many patients with cardiac syndrome X. Increased sympathetic drive may be responsible for the “ischemia-like” ST-segment depression observed during exercise. This hypothesis is supported by the observation of improved responses with β blockade, improved coronary flow reserve with α blockade, and abnormal reactivity to vasoconstrictor mediators in arteriolar resistance vessels.
      • Kaski J.C.
      Syndrome X a heterogenous syndrome.
      Because of these responses, we hypothesized that transcendental meditation (TM), a behavioral relaxation technique, may provide an effective method for modulating sympathetic overactivity in this condition. This pilot study aimed to determine whether beneficial effects might be observed using TM in patients with syndrome X. TM was selected as a standardized relaxation method with a high compliance rate and favorable research history.
      • Sharma H.M.
      • Alexander C.N.
      Maharishi Ayur-Veda research review. Part 1.
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