Enhanced External Counterpulsation (EECP)

Coronary Heart Diseases like Angina (chest pain) Myocardial Enhanced external Counter pulsation (EECP) is a noninvasive technique to treat infarction (Heart Attack) and Heart failure. It acts by increasing perfusion of blood (coronary blood flow) to the heart and diminishes symptoms of ischemia; leading to improved functional capacity and quality of life. FDA (USA) and NHS (U.K) have approved EECP therapy for the above-mentioned conditions.

The FDA (U.S.A) approved EECP in 1997; however, the idea behind it was developed in the 1950s. In EECP, 3 air cuffs are placed on each of your legs one on the calf, one on the lower thigh, and one on the upper thigh. The patient lie’s on a table and is connected to an electrocardiogram (ECG) monitor. The ECG measures hearts electrical activity, and the cuffs inflate and deflate in response to these signals. When the heart relaxes between heartbeats (the period known as diastole), the 3 cuffs rapidly inflate. This propels blood back to the heart. The cuffs quickly deflate just before the next heartbeat. The cuffs are timed to inflate and deflate based on the patient’s electrocardiogram. During the inflation portion of the cycle, the calf cuffs inflate first, then the lower thigh cuffs and finally the upper thigh cuffs. A pressure monitor controls inflation, and the cuffs are inflated to about 200 mmHg.

This inflation/deflation cycle occurs about 60 to 80 times per minute during an EECP session. Sessions last approximately 1 to 2 hours and are scheduled once a day. A full course of EECP treatment lasts 5 days a week for 7 weeks, with about 35 hours of treatment time.

EECP works by the following mechanism:

• EECP triggers the body to create tiny blood vessels (known as collaterals) that act like a natural bypass, carrying blood around larger blocked vessels. Chest pain is then reduced because the heart is again able to receive oxygen-rich blood.
• It acts by decreasing the after load that the heart has to pump against, and increase the preload that fills the heart, increasing the cardiac output. In this way, EECP is similar to the intra-aortic balloon pump (IABP). Since it increases pressure in the aorta while the heart is relaxing (during diastole) EECP also increases blood flow into the coronary arteries, which also occurs during that phase.
• Another theory is that cuff inflation/deflation increases the force of the blood flow to the heart, causing the cells lining the blood vessels to produce chemicals that widen the blood vessels, allowing blood to flow through more freely.

EECP is a noninvasive procedure, meaning that you are not cut open. There are no needle pricks, either. This means that EECP is very low risk. The morbidity and mortality associated with EECP are negligible as compared to angioplasty or Bypass surgery. You also don’t need to take any special medication before or after therapy. Some people may feel minor pain in their legs and back.

EECP may be considered if you suffer from

• Angina pain (chest pain)
• Patients suffering from single vessel or dual vessel coronary vessel disease (Patients of atherosclerosis plaque in arteries / blocked arteries)
• Patients with heart failure and congestive heart failure
• Patients who have suffered myocardial infarction (Heart Attack) and have had angioplasty or bypass surgery but continue to suffer from chest pain or other symptoms.
• Patients who cannot undergo Angioplasty or Bypass because they are too weak or have too many co morbidities (complications) to undergo bypass surgery or angioplasty, and are looking for an alternative to heart therapy.
• Patients who are looking for a natural alternative to bypass surgery or an alternative to angioplasty because they have already undergone these surgeries in the past and their conditions have recurred
• Patients who cannot afford bypass surgery or angioplasty
• If you are suffering from Cardiomyopathy

• It is cost effective, non-invasive, non-surgical, and non-pharmaceutical, out patient therapy for Angina, Heart attack and heart failure patients. It is FDA (USA) and NHS (UK) approved.
• It substantially improves quality of life and diminishes chances cardiac events in future.
• Studies have shown that EECP is a safe and effective treatment for chronic chest pain.
• The frequency and intensity of angina attacks are reduced, and many patients find that they don’t need to take their angina medication (usually nitroglycerin) as often.
• Men and women treated with EECP report having a higher quality of life after EECP, and many are able to exercise for longer periods without experiencing chest pain.
• EECP seems to work equally well in both genders, with women receiving the same chest pain reduction and quality of life benefits as men from the treatment.

A study of 5022 patients in 92 centers, conducted by the International Registry of EECP / ECP Patients showed 5 year survival rates of:

• 88% for EECP / ECP Patients
• 78% for Patients on Heart Medication only
• 86-89% for Patients of Bypass or Angioplasty

EECP external Counterpulsation therapy is a non-invasive treatment for patients with myocardial ischemia and is indicated for use in stable and unstable angina pectoris, congestive heart failure, acute myocardial infarction, and cardiogenic shock. The U.S. Food and Drug Administration (FDA) cleared Vasomedical EECP® therapy systems in February 1995 for patients with stable and unstable angina. In June 2002, FDA cleared EECP therapy for congestive heart failure (CHF). Other indications for use of EECP therapy include acute myocardial infarct (MI) and cardiogenic shock. EECP therapy is a non-invasive treatment for patients who are refractory to or inappropriate for other interventions.

The NHS (U.K) and also has approved EECP therapy.

The cost of treatment usually depends upon the package and duration of treatment.

The cost of EECP therapy is covered by medical insurance in the US, UK and many European countries; it is not covered in India. The cost of EECP is quite affordable in comparison to Surgery.