Adjunctive Relaxation Modalities (Deep Breathing and Murottal Therapy) For Pain and Hypertension Control in Non-ST-Elevation Myocardial Infarction (NSTEMI): A Case Study

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Non-ST-Elevation Myocardial Infarction (NSTEMI) with hypertensive emergency (n=1). Intervention: Deep breathing relaxation and Murottal audio therapy vs. Baseline (no comparison group). Primary outcome: Chest pain score (Numeric Rating Scale).

Rita; Hanida Hani Mohd Mokhtar; Fitri Arofiati; Noor Hanita Zaini

doi:10.31436/ijcs.v9i3.527

September 1, 2026INTERNATIONAL JOURNAL OF CARE SCHOLARSOpen Access

Adjunctive Relaxation Modalities (Deep Breathing and Murottal Therapy) For Pain and Hypertension Control in Non-ST-Elevation Myocardial Infarction (NSTEMI): A Case Study

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Key result

Adjunctive deep breathing and audio therapy cuts chest pain ~3 points in NSTEMI case.

n=1

Why the study?

NSTEMI with hypertensive emergencies carries a high mortality risk in elderly patients, and evidence-based nursing interventions for chest pain management need exploration.

Does adjunctive deep breathing and Murottal therapy improve chest pain and hemodynamics in a patient with NSTEMI and hypertensive emergency?

Key Points

To explore the application of evidence-based nursing interventions, specifically deep breathing and murottal therapy, in managing chest pain and acute hypertension during non-ST-elevation myocardial infarction.
Evaluated a 77-year-old male (N=1) presenting with NSTEMI, severe chest pain, and a hypertensive emergency with baseline blood pressure of 201/100 mmHg and troponin I of 40,065 pg/mL.
Administered guideline-directed pharmacotherapy (fondaparinux, dual antiplatelets, atorvastatin, perindopril, and pantoprazole) alongside adjunctive slow diaphragmatic breathing and murottal audio therapy (Surah Ar-Rahman).
Conducted serial hemodynamic assessments and monitored self-reported pain using the Numeric Rating Scale over a 24- to 48-hour inpatient monitoring period.
Chest pain score decreased from 7/10 at baseline admission to 6/10 post-initial stabilization and to 4/10 at the 24- to 48-hour follow-up.
Blood pressure decreased from 201/100 mmHg at baseline to 161/99 mmHg after initial stabilization and reached 152/95 mmHg at 24 to 48 hours.
Heart rate dropped gradually from 65 bpm to 58 bpm with preserved sinus rhythm and maintained peripheral oxygenation (SpO2 99% to 98% on room air).

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does adjunctive deep breathing and Murottal therapy improve chest pain and hemodynamics in a patient with NSTEMI and hypertensive emergency?

P

Population

A 77-year-old male with NSTEMI and a hypertensive emergency, managed and monitored over a 48-hour inpatient period.

I

Intervention

Slow diaphragmatic deep breathing combined with Murottal audio therapy (Surah Ar-Rahman) administered for 15-25 minutes per session daily over 3 consecutive days, added to guideline-directed medical therapy (fondaparinux, aspirin, clopidogrel, atorvastatin, perindopril, and pantoprazole).

O

Outcome

Reduction in chest pain severity (measured by Numeric Rating Scale) and hemodynamic stabilization (blood pressure reduction) over 24-48 hours.patient reported

Main Result

Absolute Event Rate: 4% vs 7%

Adjunctive non-pharmacological relaxation modalities, such as deep breathing and Murottal audio therapy, can safely complement standard medical therapy to alleviate acute chest pain and support safe blood pressure reduction in patients with NSTEMI and hypertensive emergencies.

Limitations

Pain severity was evaluated using self-reported Numeric Rating Scale scores, which are susceptible to subjective bias.
Observations were restricted to the inpatient monitoring period (24 to 48 hours), precluding assessment of long-term cardiovascular outcomes.
Single case report with no comparison group, meaning improvements may be heavily influenced by concurrent pharmacological treatment.
Subjective assessment: Pain severity was evaluated using self-reported Numeric Rating Scale scores, which are susceptible to individual subjective bias.
Short follow-up period: Observations were restricted to the inpatient monitoring period (from 24 to 48 hours), precluding assessment of long-term hemodynamic persistence or post-discharge cardiovascular outcomes.
A single case report: There is no comparison group thus, the observed improvements may also be influenced by concurrent pharmacological treatment.

Implication

Should not yet change NSTEMI practice; single case leaves open adjunctive benefit for confirmation in trials.

Abstract

Background: NSTEMI is an acute coronary syndrome characterized by elevated cardiac biomarkers without persistent ST-segment elevation. This syndrome carries a high risk of mortality in elderly patients with hypertension. This can increase the workload of the heart and trigger ischemia due to extreme blood pressure and an imbalance in oxygen supply and demand. Objective: To explore the application of evidence-based nursing interventions in the management of chest pain in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) with hypertensive emergencies. Case: A 77-year-old man with NSTEMI and a hypertensive emergency presented with chest pain, shortness of breath, and nausea. Initial examination revealed a blood pressure of 201/100 mmHg, an ECG with ST-segment depression and T-wave inversion in the inferior leads, troponin I level (40,065 pg/mL). Pharmacological therapy fondaparinux, atorvastatin, plavix, cardiprin, pantoprazole, starting perindopril. Serial monitoring revealed a decrease in chest pain score (from 7 to 4), a gradual decrease in blood pressure (from 201/100 mmHg to 152/95 mmHg). Discussion: This case emphasizes the importance of comprehensive management of NSTEMI with hypertension, including blood pressure control, therapy according to guidelines, and evidence-based nursing interventions. Deep breathing relaxation techniques and murottal therapy have been shown to be effective in reducing chest pain, decreasing anxiety, and improving physiological function by increasing oxygenation and the relaxation response. Conclusion: Management of NSTEMI with hypertensive emergencies requires an integrated approach, including guideline-based medical therapy and evidence-based nursing interventions. Deep breathing techniques and murottal therapy have been proven effective in reducing pain, stabilizing hemodynamics, and improving quality of life in elderly patients.

Discussion

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Cite This Study

Rita et al. (2026) conducted a case report in Non-ST-Elevation Myocardial Infarction (NSTEMI) with hypertensive emergency (n=1). Deep breathing relaxation and Murottal audio therapy vs. Baseline (no comparison group) was evaluated on Chest pain score (Numeric Rating Scale). Adjunctive deep breathing and Murottal audio therapy reduced chest pain score from 7 to 4 and stabilized blood pressure from 201/100 to 152/95 mmHg within 48 hours in a 77-year-old NSTEMI patient.

synapsesocial.com/papers/6ad0fce415427f6a840403d1 https://doi.org/10.31436/ijcs.v9i3.527

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Adjunctive Relaxation Modalities (Deep Breathing and Murottal Therapy) For Pain and Hypertension Control in Non-ST-Elevation Myocardial Infarction (NSTEMI): A Case Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Adjunctive Relaxation Modalities (Deep Breathing and Murottal Therapy) For Pain and Hypertension Control in Non-ST-Elevation Myocardial Infarction (NSTEMI): A Case Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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