What is coronary artery disease and why should I care?

Coronary artery disease is the most significant cause of heart related medical illness. It is caused when plaque builds inside the walls of the blood vessels (the coronary arteries) feeding the heart. This can lead to reduced or blocked blood flow to the heart. If the heart muscle does not get sufficient oxygen and nutrients from the blood, the cells of the heart become injured or permanently damaged. Doctors use terms like “acute coronary syndrome” or “myocardial infarction” to describe the injury or death of the cells.

The five risk factors you need to know:

There are five generally recognized risk factors for coronary artery disease. They are

1) family history
2) smoking
3) high cholesterol
4) diabetes
5) high blood pressure.

Four of the five risk factors can be helped by change of behavior and/or medication. Of those four, blood pressure has been the only risk factor studied in relation to music.

Can music help reduce your blood pressure?

Studies involving music and music therapy have been conducted in the hospital on patients receiving cardiac catheterizations. A cardiac catheterization is a procedure where a special tube is inserted in the groin area, a wire is threaded up to the heart, and dye is injected to visualize the coronary vessels. More than one million Americans have this procedure done each year. A study by W.J. Hamel attempted to see if anxiety could be decreased in patients waiting for their scheduled cardiac catheterization (1). Hamel played a CD titled “Trance-Zendance” (2) to “subjects from one inner city hospital.” He found that patients who received 20 minutes of this music prior to their procedure experienced less anxiety but had no significant reduction in their heart rate and blood pressure when compared to a group who received no music. Of note, the patients did not get to choose their own music for this study. I wonder if “Trance-Zendance” may have been the ideal selection for this patient population.

Another more recent study (April 2003) was conducted by Kathy Bally and published in Critical Care Nurse. She took 113 patients who were waiting for their catheterizations and randomized them into two groups. The examiner then provided the experimental group with a choice of recordings. They were permitted to listen to them at any time before, during, or after the procedure. The control group had no music. The results of this experiment did not show any significant difference in the level of anxiety or in blood pressure reduction when compared to the control group (3). It is important to note that patients undergoing this invasive procedure routinely are administered strong anti-anxiety drugs. Many of them are also taking medications which affect their heart rate and blood pressure. It is not known what effect, if any, these medications had on the study results.

Pachelbel Canon to the rescue?

A very well done and elegant study on the effects of music on blood pressure, heart rate, and subjective anxiety was conducted on 87 students by psychologists Wendy E.J. Knight and Dr. Nikki Rickard at Monash University in Australia. All were told that they had to give an oral presentation on a difficult subject, such as “the use of statistics in psychology.” Their talk would be videoed and evaluated by staff members and a student researcher. The students were randomized into two groups. They then were led to the testing rooms and told that they had 12 minutes to prepare for their talk. After 12 minutes, they were given fictitious presentation times. Each testing room was fitted with a “Denon Hi-Fi system.” The treatment group was exposed to music, and the control group had none. A recording of the Pachelbel Canon in D was used and was played a total of three times for the treatment group (the piece lasts about seven minutes). [Author’s note: the Canon is a very popular, slow, smooth and stately piece which is often played as a bride-and-groom walk ‘down the aisle.’ The cello part is particularly repetitive.] Most of the subjects knew the Canon and the researchers assumed that by playing the music three times, a familiarity would develop with those who were unfamiliar with it. Measurements were taken of blood pressure, heart rate, cortisol and salivary IgA (hormones which are sometimes elevated during stress). They found that those subjects who were exposed to the Canon were able to blunt the effects of the experimental stress significantly more than those who had not listened to music. The study showed that the music ‘treatment’ prevented significant increases in subjective anxiety, systolic blood pressure, and heart rate. [Author’s note: perhaps the results from this study could be effectively validated at an oral board exam for emergency medicine…] (4)

Bring in the Surgeons…

Finally, Drs. Karen Allen and Jim Blaschovich astutely recognized that many surgeons listened to music while performing their art. No studies had been conducted using them as subjects. They enlisted 50 surgeons who were self-reported music enthusiasts and regularly listened to music during surgery. The surgeons then had to perform a stressful mathematical test under three different conditions. The conditions were 1) silence; 2) with Pachelbel’s Canon; and 3) with a tape of their own favorite music. The researchers measured skin conduction changes, blood pressure and heart rate. They found that those who listened to music improved their performance of the task and reduced their physiologic stress response. Of note, they performed best when they listened to the music they (the surgeons) had supplied for the study. Allen and Blaschovich have a very witty conclusion to their paper which we believe is worth mentioning: “In 1889, Nietzsche wrote, “Without music life would be a mistake.” Over a century later, our data prompt us to ponder if, without music, surgery would be a mistake.” Their findings led to a publication in the prestigious Journal of the American Medical Association (5).

What about alternative therapies?

There has been a lot of interest recently in alternative therapies to help prevent disease. A recent front cover story from Forbes Magazine (November 29, 2004) has a picture of a young, healthy-appearing masculine hand throwing a bunch of pills into a steel waste container (6). The title of this story displayed on the Forbes website is “Say No to Prescription Drugs.” While we feel this is very irresponsible reporting, we do believe that other non-prescription therapies such as music may be used as an adjunct to conventional medical therapy. It is our sincere wish that researchers continue to explore the role of music as a means to better health.

We at E.R. Music are grateful to readers who inform us about new research being published involving music and cardiology. We will review the studies and incorporate them into this chapter. Please join our mailing list if you would like to be informed of the latest developments.

Copyright 2008, E.R. Music, LLC

1) Hamel, “The effects of music intervention on anxiety in the patient waiting for cardiac catheterization,” Intensive and Critical Care Nursing, (2001)17, 279-285

2) Halpern S 1995 “Trance-Zendance.” Open Channel Sound Company, California

3) Bally, Kathy, “Effects of patient-controlled music therapy during coronary angiography on procedural pain and anxiety distress syndrome,” Critical Care Nurse, April, 2003

4) Knight, Rickard, “Relaxing Music Prevents Stress-Induced Increases in Subjective Anxiety, Systolic Blood Pressure, and Heart Rate in Healthy Males and Females,” Journal of Music Therapy, XXXVIII(4), 2001, 254-272

5) Allen, Blascovich, “Effects of Music on Cardiovascular Reactivity Among Surgeons,” JAMA, September 21, 1994, Vol 272, No. 11