Anxiety, a state of uneasiness or apprehension toward a vague or nonspecific threat, is prevalent in cardiac patients. Estimates are as high as 70% to 80% during the acute phase,1,2 and it persists long-term in 20% to 25% of patients. Anxiety inflicts its toll through 3 major pathways. In the physiological pathway, anxiety affects the muscu-loskeletal system by causing muscular tension; the autonomic nervous system by arousing sympathetic responses; and the psychoneuroendocrine system (hypothalamic-pituitary-adrenal axis) by triggering secretion of catecholamines and glucocorticoids (see FigureF1). The psychological pathway elevates negative mood states, whereas the social-behavioral pathway promotes disconnection from self and others and stress inhibition with resultant unhealthy lifestyle behaviors.3,4 The deleterious effects of this psychophysiological stress response are troublesome because anxiety is an independent predictor of arrhythmic/ischemic complications and increased mortality in cardiac patients.4...

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