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 daily activity.

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 symptoms.

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 revascularization procedures.

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 ventricular dysfunction
• Patients for whom nitrates are not providing adequate relief from angina
• 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) 423-9388.