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Enhanced External Counter Pulsation (EECP) Print E-mail
by Ron Kennedy, M.D., Santa Rosa, CA

Dr. Kennedy Enhanced External Counter Pulsation (EECP) is a non-invasive way of assisting circulation which is rapidly coming to replace bypass surgery in many cases involving angina pectoris. It is a treatment for ischemic heart disease which improves heart function by enhancing circulation through the coronary vessels using a pressure suit which fits the lower half of the body.

"Enhanced" refers to the equipment that has evolved over decades of research and development to become the state-of-the-art treatment delivery system now used in EECP treatment centers. "External" means that treatment happens outside of the patient's body and doesn't require surgery.

The system compresses the legs from the ankles through the thighs and (optionally) buttocks sequentially by inflating three sets of flexible, fabric cuffs during the resting phase of the heart cycle (diastole). This results in the movement of blood from the legs toward the heart through both the arterial and the venous systems. Pressure is applied with the timing and duration of each pulse and is synchronized with the patient's heart beat. This transmits back pressure through the arterial system.

In other words, each wave of pressure is electronically timed to a heart beat, so that the increased blood flow is delivered to the heart at the precise moment it is relaxing. When the heart begins to contract again, pressure is released instantaneously. This lowers resistance in the blood vessels of the legs so that blood may be pumped more easily from the heart, decreasing the amount of work required of the heart muscle. During counterpulsation the EECP system pumps when the heart is resting and releases pressure when the heart is contracts.

The aortic valve, the valve located at that point where the blood leaves the large (left) ventricle, prevents back flow into the left ventricle. The coronary arteries come off the aorta just above the aortic valve so that the increased diastolic pressure which results from the counter pulsations applied to the lower extremities drives extra blood through the coronaries, thus expanding networks of tiny
auxiliary blood vessels, thereby increasing the amount of blood flowing to heart muscle. The therapeutic benefit which is seen over time is that new blood vessels form creating a natural bypass. This is thought to occur due to the release of "angiogenic" (i.e. vessel forming) growth factors.

The result of EECP is to speed up a process which is already happening: the development of collateral circulation. This is, however, a gradual process and not everyone has the same natural ability to develop these networks at a rate that will relieve symptoms.

The typical treatment regimen for chronic angina patients is 35 hours of treatment, usually one hour per day, five for days per week for seven weeks. Some patients choose a 2-hour per day regimen, which reduces the time to completion to 3-1/2 weeks. Treatment can be given lasting up to four hours, with a 10 minute rest period after each hour of treatment. The duration of treatment and rest intervals will depend on the patient's condition, the degree of diastolic augmentation obtained, patient tolerance and the indications for application of the device.

The following are indications for use for external counter pulsation therapy:

Acute Myocardial Infarction
Cardiogenic Shock (loss of blood pressure)
Angina Pectoris, both Stable and Unstable

Patients with varying degrees of left ventricular dysfunction have demonstrated improvement with external counter pulsation. These patients frequently show:

Less recurrent chest pain
Less ventricular fibrillation
Reduction or elimination of shock symptoms
Decrease in heart size (in cases where the heart has increased to an abnormal size)
Less progression to cardiac failure
Increased quality of life
Decreased mortality rates

Patients with normal left ventricular function but with coronary artery disease may benefit from External Counter Pulsation treatment in obtaining symptomatic relief of angina pectoris. The system may also be useful in emergency situations in place of dangerous invasive procedures, and in all situations where diastolic blood pressure augmentation may provide therapeutic benefits.


The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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