Norfolk County Cardiologist Association
A new therapy for angina pectoris
A patients guide to Enhanced External Counterpulsation.
If you suffer from chronic angina pectoris, your physician may consider you a candidate for EECP (Enhanced External Counterpulsation), a noninvasive treatment for patients like yourself. This booklet is designed as an introduction to EECP and its possible benefits. Your physician will be able to answer any additional questions you may have about this treatment.
HOW YOUR HEART WORKS
Your heart is basically a hollow muscular organ consisting of two pumps. Each pump (one on the right and one on the left) is divided into two chambers that are linked by passageways in which there are valves to ensure that he blood flows only in one direction. The left ventricle, which must pump blood out into the body through a large blood vessel (the aorta), is a chamber of the heart that works hardest, and; therefore, has the greatest need for oxygenated blood.
The blood’s cycle through your heart begins when oxygen-depleted blood returns to the heart, entering the right upper chamber (atrium) via the largest veins, called the vena cavae. From the right atrium, blood passes through a valve to the right lower chamber (ventricle). It is then pumped through the pulmonary artery into the lungs where it receives oxygen.
This freshly oxygenated blood then flows through the pulmonary veins into the left atrium and then into the left ventricle. From the left ventricle, blood is pumped through the aorta out into your body again.
WHY TREATMENT WITH EECP MAY BENEFIT PATIENTS WITH ANGINA PECTORIS.
Your heart pumps blood throughout your entire body to supply tissues with the oxygen and other nutrients they need. In order to do this, the heart itself needs oxygen-enriched blood to generate the energy it requires. Because the heart muscle is unable to obtain this energy directly from the blood it pumps, it relies upon its own set of blood vessels - the coronary arteries - for oxygen-enriched blood.
The coronary arteries are distinct from other arteries in the body in that maximal blood flow occurs during diastole (when the heart is relaxing). This is because when the heart contracts, the coronary vessels are squeezed and cannot carry enough blood at that time.
In some people, the coronary arteries can become narrowed or obstructed so that during exercise or stressful situations, an insufficient amount of oxygen-enriched blood is able to reach some parts of the heart muscle. Often, the result is a painful experience called angina pectoris.
WHAT IS ENHANCED EXTERNAL COUNTERPULSATION?
EECP is a nonsurgical, mechanical procedure that can reduce the symptoms of angina pectoris, presumably by increasing coronary blood flow in ischemic areas of the heart. The beneficial effects of EECP in patients with coronary artery disease appear to be sustained between treatments and may persist long after completion of a course of therapy.
WHAT DOES THE EECP PROCEDURE INCLUDE?
While EECP is performed, you will be lying on a bed wearing a series of pressure cuffs (like large blood pressure cuffs) around your calves, lower thighs, and upper thighs.
The EECP system includes a pressure source that inflates and deflates those cuffs. The pressure moves the blood from your lower limbs toward the heart. The vascular networks in the large muscles of your legs are compressed in sequence, progressing from the valves upward. Each wave of pressure is electronically synchronized with your heartbeat via an electrocardiographic signal, so that the increased blood flow is delivered to your heart at the precise moment it is relaxing and blood flow through the coronary vessels is at its peak. When the heart pumps again, the pressure in the cuffs is withdrawn and the cuffs are deflated instantaneously. This lowers resistance in the vascular bed of your legs so that blood may be pumped more easily from the heart.
WHAT DOES THE TREATMENT INVOLVE AND HOW LONG DOES IT TAKE?
Treatment with EECP involves a series of 35 one-hour sessions over a period of approximately seven weeks. You must report to the medical center in time for each scheduled appointment and allow extra time to change into appropriate attire before therapy begins.
WHAT ARE THE PHYSICAL EFFECTS OF EECP? IS IT UNCOMFORTABLE?
The one-hour treatment sessions with EECP are painless. Because of the natural movement of the pressurized cuffs, chafing and skin irritation can occur. To prevent this, you are advised to wear tight fitting pants, such as ankle length bicycle pants. Otherwise, there is virtually no discomfort. Many patients find they are able to read, listen to their favorite music and tapes, or otherwise relax during therapy.
Since it is timed by your heartbeat, the EECP system will automatically turn off if your heartbeat goes above or below a specific rate. If you have any specific concerns about the effects of EECP or your own physical limitations, you should consult your private physician.
MUST YOU DO ANYTHING SPECIAL TO PREPARE FOR TREATMENT?
Since you have been selected as a candidate by your physician, little else is required in the way of preparation.
ARE THERE ANY PRECAUTIONS TO TAKE WHILE RECEIVING TREATMENT?
You should continue taking your medication at the regular prescribed dosages throughout the course of treatment and confer with your physician as needed.
ARE THERE ANY ADVERSE REACTIONS RELATED TO TREATMENT WITH EECP?
There are no known adverse effects as a result of receiving treatment with EECP.
HOW SOON CAN I EXPECT TO FEEL AN IMPROVEMENT IN MY CONDITION?
Because each individual’s condition is unique, there is no specific time when you can expect to feel an improvement. Experience has shown; however, that patients tend to report some improvement in their condition after as few as 10 or 12 treatment sessions, although other do require longer.
WHAT BENEFITS MIGHT I EXPERIENCE FROM THIS TREATMENT?
EECP can have a range of benefits depending upon the individual patient. Most patients suffering from chronic disabling anginal pectoris have experienced relief of pain associated with this condition after a full course of treatment.
In a study of patients with chronic disabling angina, all experienced substantial relief of anginal symptoms after treatment with EECP. Typical benefits for patients might include:
Decrease in chest pain
Reduction in the use of medication
Ability to enjoy a more independently mobile and active lifestyle.
While it is not expected that everyone suffering from chronic angina pectoris will experience the same level of improvement, it does appear that EECP is an effective therapy for many angina patients.