Enhanced External Counterpulsation (EECP®)
Primary care physicians and cardiologists who confront angina on a daily basis know that it is a major unresolved health problem that can exact a huge personal toll. The limitations of current CAD therapy leave many patients with debilitating angina and compromised quality of life. EECP® offers hope and help.
Enhanced External Counterpulsation® treatment is a noninvasive, outpatient procedure to relieve angina by improving perfusion in areas of the heart deprived of adequate blood supply.
Frequently asked questions
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 three-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 hours divided into one or two 60-minute treatment sessions five days per week. Patients who undergo two treatment sessions in one day rest between sessions.
EECP® treatment uses unique equipment 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.
While the heart is at rest the cuffs are inflated in rapid sequence from the calves upward, creating a pressure wave that increases diastolic 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 contraction lowers the resistance the heart must pump against, decreasing the heart's work load. This latter effect, when coupled with increased venous return, significantly raises cardiac output. The overall effect is to increase the oxygen supply of the heart, while decreasing its oxygen demand.
Significant obstruction in one or more coronary arteries can create a pressure difference between areas of the heart muscle that receive and those that do not receive enough blood. Repeated and pulsed increases in pressure during diastole may stimulate opening or formation of collateral channels across this pressure gradient within the heart muscle, resulting in increased blood supply to deprived tissues.
Contraindications to EECP®
- Cardiac catheterization within one to two weeks to minimize the likelihood of bleeding at the femoral puncture site.
- Arrhythmia that might interfere with the triggering of the EECP® treatment system such as atrial fibrillation, atrial flutter, ventricular tachycardia.
- Uncontrolled congestive heart failure. In some patients, left ventricular unloading may be insufficient to compensate for increased venous return during EECP® treatment.
- Aortic insufficiency where regurgitation would prevent diastolic augmentation.
- Limiting peripheral vascular disease (PVD) and/or phlebitis because of increased risk of thromboembolus. Severe PVD with reduced vascular volume and diminished musculature of the lower extremities can compromise effective counterpulsation.
- Severe hypertension (>180/110 mm Hg). Under these circumstances, EECP® treatment could produce diastolic blood pressure levels surpassing acceptable limits.
- Bleeding diathesis, Coumadin® (warfarin, Dupont Merck) therapy with PT>15 because the pressure of cuff inflations might cause bleeding in leg muscles.
- Pregnant women and women of childbearing potential who do not employ a reliable contraceptive method to avoid possible danger to fetus.
For information about EECP® at Jackson Purchase Medical Center, call (270) 251-4399.
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