The length of treatment may be a consideration for some people. It can take between four to seven weeks to complete a course of EECP treatment. During that time, patients must visit an outpatient clinic and receive treatment for one to two hours per day. Some patients with more extensive disease may require more than one course of therapy to achieve optimal relief.

Unlike procedures such as bypass surgery and balloon Angioplasty, EECP treatment is administered in outpatient session, carries little or no risk, and is relatively comfortable.Some patient with more extensive disease or who have disease of the left main coronary artery may require bypass surgery. EECP treatment is an option for patients who are unsuitable for invasive procedures or unwilling to undergo them. For patients who have undergone multiple invasive procedures and for whom additional surgery carries excessive risk, EECP treatment may be the only way to obtain relief from crippling angina.

Enhanced External Counterpulsation (EECP) / External Counter pulsation (ECP) was cleared by the Federal Drug Administration (FDA) in 1996. Medicare/Medicaid insurance coverage began in 1999. Leading cardiology centers like Mayo Clinic and Cleveland Clinic use ECP.

The cardiologist assesses:
Treadmill exercise time
Time to ST segment depression
Stress perfusion study at the same cardiac work load (83%) (American Journal of Cardiology, April 2002)
Ejection fraction
End diastolic filling pressure
Regional ischemial and regional myocardial blood flow reserve evaluated by ammonia positron emission tomography

Angina often occurs when exertion outstrips the ability of narrowed or blocked coronary arteries to supply blood to the heart muscle. Angina restricts activity for many patients. They are able to walk on flat surfaces, but not uphill nor while carrying packages. For some, angina is disabling as it interferes with their ability to work or engage in almost any activity.

Normal heart function depends on maintaining a balance between oxygen supply and demand. Oxygen consumption by the cardiac muscle is determined by how fast your heart is beating and how well it pumps. The amount of oxygen available is determined by blood flow. Approximately 80 percent of the blood flow to the cardiac muscle tissue occurs when the heart is resting.

Clinical studies indicate that ECP treatment may create a 'natural' bypass of blocked arteries. ECP treatment encourages blood vessels to open or form small channels that become extra branches. These channels or collaterals may eventually become permanent pathways to the heart muscle that was previously deprived of blood flow and adequate oxygen.

In 1989, researchers at the State University of New York at Stony Brook began clinical studies of ECP treatment. Until the summer of 1995, ECP therapy was only available to patients participating in clinical studies. Today, ECP treatment is available at treatment centers throughout the world.

Patients typically attend one hour treatment sessions once a day, five days a week, for seven weeks. Many people have continued their employment while receiving treatment by scheduling their session before or after work. Patients with extensive atherosclerotic disease may require more than 35 hours of treatment to achieve optimal benefit.

ECP is the only treatment which is neither invasive nor pharmacological
ECP is a completely non-invasive and outpatient procedure
ECP treatment carries very low or no major adverse event during treatment
ECP is effective in small vessel of the heart and those that are too small for bypass surgery and angioplasty and is the main reason why ECP is still effective when other procedures have failed
The effectiveness of ECP seems to be similar in both diabetes and non-diabetes (Circulation 000; 02-18)
ECP can be safely administered even in patients with left ventricular dysfunction with ejection fraction lower than 35%
ECP benefit seems to be similar in both ischemic and idiopathic cardiomyopathy (CHF. 2002; 04-8,227)
ECP is cost effective and a very safe treatment that is painless and needs no hospitalization

There are virtually no risks. Some patients have experience minor skin irritation due to the pressure of the cuffs. You should consult with your physician regarding any risk and complication factors.

Angina signals the brain that a part of the heart muscle is not receiving an adequate supply of blood and oxygen. The heart requires a particularly rich blood supply because of its heavy workload, and receives this nourishing blood supply through the coronary arteries. When narrowed or blocked arteries restrict blood flow, oxygen supply to portions of the heart may at times be insufficient. Increase in oxygen demand can occur during exercise, fever, rise in emotion, periods of hypoglycemia, or after meals, triggering the onset of angina.

After ECP treatment the patient will experience the following benefits:
Increase exercise time without chest pain
Complete freedom from agonizing chest pain or decrease in the chest pain frequency and intensity
Improvement in overall health
Decrease or no need for anti-anginal medications
Patients feel more comfort for participating in social activities without fear of getting chest pain
Some patients with severe three-vessel disease may need more than 35 hrs of treatment, which will be determined by his cardiologist by assessing his improvement. Usually one course of treatment is sufficient up to 5 yrs according to the available long time follow up study. Few patients may require additional course of treatment according to the severity of coronary artery disease.

Patients lie on a padded table in a treatment room. Three electrodes are applied to the chest to record a constant ECG reading. A finger sensor called a plethysmograph, records a tracing that represents blood pressure. A set of cuff is wrapped around the calves, thighs and buttocks. The system uses an ECG signal to electronically synchronize inflation and deflation of the cuffs. Patients experience a sensation of strong 'hug' moving upward from calves to thighs to buttocks during inflation followed by the rapid release of pressure on deflation. During ECP treatment, a display shows an ECG signal and a blood pressure tracing. An ECP therapist uses these readings to time counterpulsation and monitor treatment.

Angina pectoris literally means 'strangling in the chest'. It is the most common symptom of coronary artery disease. The majority of patients with angina complain of chest discomfort provoked by mental, physical or emotional stress. The discomfort can vary widely among patients who report shortness of breath, fatigue, indigestion, faintness, pain in the chest, arm, neck, or jaw and other symptoms.

Data reported in the April, 2000, issue of Clinical Cardiology, showed a five year survival rate for those who responded to EECP therapy of 88%, a rate similar to those seen in contemporary surgical bypass and angioplasty trials, despite the fact that many of the patients who underwent EECP therapy had already failed previous attempts at revascularization.

Usually the patients start experiencing improvement in 10 to 15 days. Clinical improvements are manifested as decreased or elimination of anginal pain after exertion, longer walking distances, less intake of nitroglycerine, improved quality of life, and improvement in overall health status.

Patients can walk farther, carry heavier packages and be more active without having angina
Patients have fewer attacks of angina
Episodes of Angina are less painful
Patients need less anti-anginal medication
Patients can return to work, go out for dinner, garden, travel, enjoy golf, tennis or bowl, once again
Patients feel more confident about participating in their social lives, volunteer activities and exercise without interference from angina