EECP- Enhanced External Counterpulsation
If you have disabling angina pectoris ... chest pain that
can interfere with your enjoyment of life ... you should know about
EECP. Recently approved for Medicare coverage by the US Health Care
Financing Administration, EECP offers an alternative to bypass surgery,
angioplasty, and an important adjunct to daily medication to relieve
chest pain. EECP is a noninvasive, outpatient therapy -- you go
home every day after an hour of treatment.
Enhanced External Counterpulsation (EECP®) treatment is
a noninvasive, outpatient procedure to relieve recurrent or persistent
angina pectoris by improving blood perfusion to areas of the heart
deprived of adequate blood supply by coronary artery obstruction.
Clinical trials have confirmed the benefits of EECP® treatment.
They include: symptomatic relief of angina unresponsive to medical
therapy, improved blood flow to deprived areas of heart muscle demonstrated
by the results of thallium stress testing, elimination or reduction
of nitrate use, improved ability to exercise. In a 3-year, follow-up
study, the majority of patients remained free of angina and showed
persistent improvements in their thallium scans. Patients and their
families usually report noticeably greater ability to engage in
Patients usually receive EECP® treatment for 35-40 hours
of treatment usually carried out as a 60-minute treatment session
five days per week for seven to eight weeks.
EECP® treatment uses unique equipment developed by Vasomedical,
Inc. to inflate and deflate a series of pneumatic compressive
cuffs around the lower extremities. Treatment is administered on
a padded table where three sets of electronically controlled inflation
and deflation valves are located. These valves are connected to
specially designed adjustable cuffs that are wrapped firmly, but
comfortably around the patient's calves, lower thighs, and upper
thighs, including the buttocks. The design of the cuffs permits
significant pressure to be applied to the arteries and veins at
relatively low air pressures. Timing for inflation and deflation
is regulated by running electrocardiogram signals through a microprocessor
that monitors the treatment process.
When the heart begins its resting phase the cuffs are inflated
in rapid sequence from the calves upward (steps 1-3), creating a
pressure wave that increases diastolic blood pressure, coronary
artery perfusion pressure, and blood flow to the heart muscle. This
compression of the blood vessels in the legs also increases the
volume of blood returned to the right side of the heart via the
venous system. Instantaneous deflation of all cuffs at the onset
of the heart's next contraction (step 4) lowers the arterial resistance
the heart must pump against, decreasing the heart's workload. This
latter effect, when coupled with increased venous return, significantly
raises cardiac output. The overall effect is to increase the oxygen
supply to the heart, while decreasing its oxygen demand.
Significant obstruction in one or more coronary arteries can
create a large pressure difference between areas of the heart muscle
that receive and those that do not receive enough blood. Repeated
and pulsatile increases in perfusion pressure during the heart's
resting phase (diastole) may stimulate the opening or formation
of collateral channels across this pressure gradient within the
heart muscle, resulting in increased blood supply to deprived areas
of heart muscle.
Angina pectoris is the most common symptom of coronary artery
disease. The majority of patients with angina pectoris complain
of chest discomfort provoked by mental, physical, or emotional stress.
Discomfort can vary widely among patients who report shortness of
breath, fatigue, indigestion, faintness, pain in the jaw, and other
Previously, the primary treatment options for people suffering
from angina were medication and/or invasive procedures such as bypass
surgery or angioplasty. These invasive procedures sometimes fail,
pose significant risks and are very expensive. EECP® therapy
provides an alternative for those people who cannot be treated effectively
with medication and are unsuitable or are unwilling to undergo invasive
For many patients, EECP® treatment can provide relief without
pain or extended time for recovery. EECP® treatment can be administered
in daily, one hour, outpatient sessions. The procedure has little
or no risk and is relatively comfortable. To determine if you are
an appropriate candidate for EECP® treatment, your cardiologist
should evaluate you.
Candidates for EECP® treatment include:
- Any patients with chronic stable angina with or without left
- Patients for whom nitrates are not providing adequate relief
- Patients who do not qualify as candidates for invasive procedures
- Patients who have exhausted invasive treatments without lasting
relief of symptoms
- Patients who are unwilling to undergo surgery or angioplasty.
You may NOT be a candidate for EECP® treatment if you
have any of the following conditions/devices:
- Certain heart rhythm abnormalities
- Limiting peripheral vascular disease
- Severe high blood pressure
- Severe Aortic Insufficiency
- Bleeding diathesis
- Pregnancy or failure to employ a reliable method of birth control.
A typical course of treatment requires patients to attend
one-hour treatment sessions once a day, five days a week, for seven
to eight weeks depending on clinical response. Many patients have
continued working during the course of treatment by scheduling early
morning or late afternoon appointments. Some patients may require
more than 35-40 hours of treatment to achieve optimal benefit. The
Heart-Lung Associates' cardiologist must individualize the treatment
of each patient.
Because each person's heart's condition is unique, there
is no predictable point during treatment when you will feel an improvement.
Experience has shown, however, that many patients tend to report
some improvement in their conditions after as few as 15 treatment
sessions, although it may take longer.
Call Heart-Lung Associates of Hawthorne, NJ for more information
or to schedule a consultation with Dr. Strobeck, Dr. Strain, Dr.
Berkowitz, Dr. Greenblatt, or Dr. Buda at (800) YOUR-HLC or (973)