Impact of Music on Cardiac Patients
Neuroscientific and Endocrinological Perspectives and Underlying Mechanisms
Abstract
Abstract. Controlled studies and clinical observations can elucidate the influence of music on blood pressure and heart rate, but do not explain underlying mechanisms. Clarification of contradictory scientific results requires an understanding of corresponding psycho-neuroendocrinological processes and is also indispensable to patient-centered cardiac music therapy interventions. The paper is intended to complement the thematic issue on music therapy in cardiology (MTK 25 (1), 2014). To identify neural and neuroendocrine modules linking auditory and neurocardiac systems. This should facilitate a diagnosis-specific application of music for cardiac patients. Review of empirical, neuroanatomic, and interdisciplinary medical findings about cerebral music processing. Meta-synthesis and construction of a theoretical framework that explains the impact of music on blood pressure and heart rate. Music-induced cardiac processes can be elucidated by neural and neuroendocrine modules linking auditory processing areas and neurocardiac centers. Efferent projections from the auditory pathway as well as top–down projections arising from the auditory cortex form specific functional circuitries. Overlapping and interacting projections from cortical and subcortical regions to associative processing organs (e. g., the insular cortex) integrate both physiologically and cognitively processed sound factors (i. e., the dualistic model). Via corresponding modules the auditory system is indirectly linked to hypothalamic nuclei, influencing the hypothalamic–pituitary–adrenal axis as well as vasopressin- and oxytocin-related processes. Connections with the locus coeruleus refer to noradrenergic sound–heart regulation. Physiological mechanisms interacting with individual musical experiences require the synopsis of evidence-based findings, neuroendocrinological explanations, and differential psychological profiles for reliable treatment planning.
Zusammenfassung. Kontrollierte Studien und klinische Beobachtungen machen den Einfluss von Musik auf Blutdruck und Herzraten deutlich, decken aber keine tiefer liegende Mechanismen auf. Zudem bedarf die Klärung widersprüchlicher Forschungsergebnisse oft des Verstehens psycho-neuro-endokriner Prozesse, welche mit solchen Phänomenen zusammenhängen. Erklärende Theorien zu diesen Mechanismen helfen darüber hinaus musik-kardiologische Interventionen patientenzentriert durchzuführen. Der vorliegende Artikel nimmt damit auf das Themenheft „Kardiologie in der Musiktherapie“ (MTK 25 (1), 2014) Bezug und ist als Ergänzung zu verstehen: Identifizierung neuronaler und neuro-endokriner Module, welche das auditive and das neurokardiale System verbinden. Dies soll diagnosespezifische Anwendung von Musik bei Herzpatienten erleichtern. Auf der Basis empirischer, neuroanatomischer und interdisziplinärer medizinischer Erkenntnisse über zerebrale Musikverarbeitung wird eine Metasynthese erstellt. Das daraus entwickelte Theoriekonstrukt erklärt den Einfluss von Musik auf Blutdruck und Herzraten. Durch Musik beeinflusste Herzprozesse können durch Funktionen neuronaler und neuroendokriner Module, die Areale auditiver Verarbeitung und neurokardiale Zentren verbinden, erklärt werden. Efferente Projektionen aus der Hörbahn und absteigende aus dem auditiven Kortex formen spezifische funktionale Systeme. Information aus kortikalen und subkortikalen Regionen überlagern sich und interagieren. In assoziativen Hirnzentren (z. B. insulärer Kortex) werden diese zusammengeführt, physiologische und kognitive Faktoren integriert. In der Folge wird ein dualistisches Modell–kortikale und subkortikale Herzregulation durch Musik–eingeführt. Über korrespondierende Module ist das auditive System indirekt mit hypothalamischen Kernen verbunden, welche die Hypothalamus-Hypophysen-Nebennierenrinden-Achse und Vasopressin wie auch Oxytocin beeinflussen. Verbindungen mit dem Locus Caeruleus betreffen die noradrenerge Klang-Herz-Regulation. Physiologische auditive Mechanismen interagieren mit individueller musikalischer Erfahrung. Musik-kardiologische Interventionsplanung erfordert eine Synopse von evidenz-basierten Erkenntnissen, neuro-endokrinologischen Erklärungen und differentiell psychologischen Profilen.
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