Case Study 3

A 63-year-old man presented to the emergency room with an acute anterior wall myocardial infarction. He was treated successfully with emergency intravenous TPA. During hospitalization, the patient had a coronary arteriogram which revealed a nonsignificant stenosis in the proximal LAD, with evidence of a healing dissection.

Electrocardiogram demonstrated an evolving anterior wall myocardial infarction. The patient was subsequently seen in the office and noted to be hypertensive, with a blood pressure of 160/92 mmHg. He was referred to learn Transcendental Meditation, and was started on enalapril 10 mg/day.

His blood pressure dropped to 120/80 mmHg. On the basis of a normal blood pressure, the enalapril was discontinued. Two years later, he had a repeat exercise stress test in which there was no evidence of myocardial ischemia. Off medication, and with the regular practice of Transcendental Meditation twice daily, the patient's blood pressure was 126/80 mmHg, and he had complete normalization of his electrocardiogram.

Three years after this evaluation, due to a busy lifestyle, the patient had become irregular with lifestyle modifications and was not regular with the practice of meditation. His electrocardiogram showed left ventricular hypertrophy with ST-T wave abnormalities, T wave inversions in the anteroseptal leads, and his blood pressure had elevated to 170/90 mmHg. The patient was started on enalapril 20 mg/day, with significant improvement in blood pressure. 

One year later he had recurrence of angina. An exercise stress test demonstrated ST segment depression in the inferolateral leads, which persisted into recovery. He had a new anteroseptal wall motion abnormality on stress echocardiogram. The patient underwent diagnostic arteriography, and was noted to have restenosis at the site of the prior acute myocardial infarction. He underwent coronary artery angioplasty and stent deployment.

The patient started meditating regularly again and showed resolution of the EKG abnormalities and left ventricular hypertrophy. Two years later, he had another exercise stress test. At that time his blood pressure was 140/80 mmHg. He exercised 10 min. 23 sec. on a Bruce protocol, having a normal heart rate response to exercise. There was no angina, and he had no ischemic EKG changes. He showed normal wall motion response to exercise, ruling out any evidence of recurrence of coronary artery disease. The patient's present medical management includes 81 mg/day of aspirin, vitamin E 200 IU/day, and Transcendental Meditation twice a day.