When you have angina, your body is telling you that your heart is not receiving enough oxygen.

A treatment, in harmony with your heart, can improve circulation to your heart muscle. EECP treatment appears to stimulate the opening of new, natural pathways around narrowed or blocked arteries.

After EECP treatment you may find that:

• You can walk farther, carry heavier packages, and be more active without having angina
• You have fewer attacks of angina
• Your episodes of angina are less intense
• You can return to work, go out to dinner, garden, travel, or enjoy golf, tennis, or bowling once again
• You no longer have to restrict your social life, volunteer activities, or exercise because you are worried that they will cause angina.

Understanding Angina

If you are one of more than seven million people in the United States with angina, you may be all too familiar with angina.

Angina signals that a part of your heart muscle is not receiving an adequate supply of blood supply because of its heavy workload, and receives this nourishment through the coronary arteries. When these vessels are narrowed or blocked, restricting blood flow, they fail to supply adequate oxygen.

Detours around blocked arteries

The body has a response to pain and problems caused by narrowed arteries. The body often can increase the amount of blood flowing to the muscle by opening up tiny branches of nearby vessels. This network of tiny blood vessels- known as “collateral circulation” – makes it possible for blood to detour around blocked or narrowed arteries.

The development of collateral circulation is particularly important in the heart muscle where it may be life-saving. However, the development of collateral circulation is a gradual process and not everyone has the same natural ability to develop these networks at a rate that will relieve angina.

Learning about EECP treatment

Enhanced External Counterpulsation may stimulate the opening, or formation of, small branches of blood vessels (collaterals) to create a natural bypass around narrowed or blocked arteries.

The term “Enhanced External Counterpulsation” describes what will happen during treatment.

“Enhanced” refers to the equipment that has evolved over decades or research and development to become the state-of-the-art treatment delivery system now used in EECP treatment centers.

“External” means treatment happens outside of your body and doesn’t require surgery.

Before we can understand the term “Counterpulsation,” we have to understand the cardiac cycle, the period from the beginning of one heartbeat to the beginning of the next. The cardiac cycle includes diastole when the heart relaxes and fills with blood, and systole when the heart contracts and pumps blood out to the body

The EECP system compresses your lower limbs to increase blood flow toward your heart. Each wave of pressure is electronically timed to your heartbeat, so that the increased blood flow is delivered to your heart at the precise moment it is relaxing. When the heart pumps again, pressure is released instantaneously. This lowers resistance in the blood vessels of your legs so the blood may be pumped more easily from the heart. Decreasing the amount of work required of your heart muscle.

During counterpulsation the EECP system pumps when your heart is resting and releases pressure when your heart is working.

Determining if you may be a candidate for treatment

Your doctor will evaluate you to determine if you may be eligible to receive EECP treatment. You may be a candidate to EECP treatment if:

• You have angina
• Nitroglycerin does not provide adequate relief from your angina
• You have been told that you are not a candidate for bypass surgery or angioplasty
• You underwent bypass surgery or angioplasty in the past, and angina has returned
• You want to explore all treatment options

Some people may not be candidates for EECP treatment because of their medical conditions. Only a physician can make a decision regarding whether or not you are a candidate for EECP treatment.

Once you are eligible to receive EECP treatment, it is important that you understand the treatment schedule. Patients typically attend one-hour treatment sessions once a day, five days a week for seven weeks. Many people receive treatment, without interruption to their employment, by scheduling their session before or after work.

To make sure the treatment goes smoothly, please follow your Pre-Treatment Instructions. You may wish to bring a book, a magazine, or portable CD or tape player with earphones. You also may wish to invite a family member or friend to accompany you.

At the EECP center, your therapist will explain each step as you go through treatment. You may be given a pair of stretch pants to wear at each treatment session.

Although treatment usually takes one hour, you should plan to spend approximately 1-1/2 hours at the treatment center.

Receiving EECP treatment

Once you have changed your clothes, a therapist will weigh you, and take your blood pressure. You will lay on a padded table in a padded table in a treatment room. Three electrodes will be applied to your chest to take a constant ECG reading during treatment. A finger sensor, called a plethysmograph, will be placed over your finger like a thimble. This sensor records tracings that represent blood pressure.

The therapist will wrap a set of inflatable cuffs around your calves, thighs, and buttocks. You are likely to feel a sensation of a strong “hug” moving upwards from you calves to thighs to buttocks during inflation followed by rapid release of pressure on deflation.

Synchronized with your heartbeat

Inflation and deflation are electronically synchronized with your heartbeat using the ECG signal. By monitoring your ECG reading and your plethysmograph (blood pressure) tracing, your EECP therapist can time counterpulsation accurately.

Raising the threshold for angina

Clinical studies indicate that EECP treatment may create a “natural bypass” around narrowed or blocked portions of arteries. These channels or collaterals may eventually become permanent pathways for blood to reach heart muscle that was previously deprived of adequate nourishment.

A controlled, randomized, blinded study showed a significant increase in the length of time that participants who had received in the length of time that participants who had received active treatment were able to exercise experienced fewer attacks of angina.

Medical research

Studies conducted at numerous university medical centers and published in peer-reviewed medical journals have demonstrated benefits including:

• Elimination or decrease in exercise-included signs of lack of oxygen to the heart muscle (ischemia)
• Increased exercise tolerance
• Elimination or decrease in episodes of chest pain
• Decrease in need for anti-anginal medication

Many patients ask these questions

What are the clinical benefits of treatment?
For many patients, EECP treatment can reduce the frequency and intensity of chest pain or eliminate it altogether, decrease the need for medication, and greatly improve the ability to participate in activities of everyday life. After receiving EECP treatment, patients often are able to enjoy moderate exercise for the first time since they developed angina.

How will I feel after treatment?
You may feel a little tired after your first treatment session, but you are unlikely to experience any unpleasant after effects. You may be given an Angina Diary in which you can record any episodes of angina and your use of nitroglycerin. This record may be helpful in tracking your progress.

How soon can I expect to feel an improvement in my condition?
Because each individual’s condition is unique, there is no special time when you can expect to feel improvement. Experience has shown that some patients tend to report some improvement about halfway through their course of treatment.

Are there any drawbacks to the procedure?
The length of treatment may be a consideration for some people. A course of EECP treatment typically takes seven weeks to complete. During that time, patients must visit an outpatient clinic and receive treatment for one hour per day. Some patients may require more than one course of therapy to achieve an optimal level of relief.

What are the risks of EECP treatment?
Some patients have experienced minor skin irritation due to the pressure of the cuffs. You should consult with your physician regarding any risk and complications factors.

What are the advantages of EECP treatment over other treatment for angina?
Unlike procedure such as bypass surgery and balloon angioplasty, EECP treatment is administered on an outpatient basis and does not involve any period of post-treatment recuperation.

Are there other treatment options to consider?
There are several other treatment options including bypass surgery, balloon angioplasty, and drug treatments. Discuss options with a physician to determine which course of treatment is not suitable for you.

Pre-Treatment Instructions

Specific instructions will be explained by your EECP therapist.

Please ask your EECP therapist any questions that you may have.

• Arrive 10-15 minutes before your scheduled appointment.
• Take all medications as instructed.
• Don’t eat (except medication) or drink within 1-1/2 hours before treatment.
• Chose clothing that’s easy to change.
  • Stretch pants, usually provided by the center, should be worn to reduce the possibility of skin irritation.
  • Men and women should wear form-fitting underwear.
  • Wear a loose, comfortable top with an open neck.
  • Wear short socks.
• You may bring music (CD player or type player with earphones) or something to read.
• A friend or relative may stay with you during your treatment.