Heart Disease: Treating Chronic Angina: EECP

When other treatments have failed to relieve persistent angina symptoms, enhanced external counterpulsation (EECP) may be an option. EECP helps stimulate blood vessels to develop small branches, creating a natural bypass around narrowed or blocked arteries that cause the angina.

How Does EECP Work?

The EECP treatment gently but firmly compresses the blood vessels in the lower limbs to increase blood flow to the heart. Each wave of pressure is electronically timed to the 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 in the legs so that blood may be pumped more easily from your heart.

EECP may encourage some small blood vessels in the heart to open. These collateral blood vessels may eventually become "natural bypass" vessels to provide blood flow to heart muscle. This contributes to the relief of angina symptoms.

What Happens During EECP Treatment?

EECP is a non-invasive, outpatient therapy. During treatment:

• Patients lie down on a padded table in a treatment room.
• Three electrodes are applied to the skin of the chest and connected to an electrocardiograph (ECG). The ECG will display the heart's rhythm during treatment. Blood pressure is also monitored.
• A set of cuffs is wrapped around the calves, thighs and buttocks. These cuffs attach to air hoses that connect to valves that inflate and deflate the cuffs. Patients experience a sensation of a strong "hug" moving upward from calves to thighs to buttocks during inflation followed by the rapid release of pressure on deflation. Inflation and deflation are electronically synchronized with the heartbeat and blood pressure.

How Often Are Treatments?

Patients who are accepted for treatment must undergo 35 hours of EECP therapy. Treatment is administered 1-2 hours a day, five days a week, for 7 weeks.

Who Is a Candidate for EECP?

You may be a candidate if you:

• Have chronic stable angina.
• Are not receiving adequate relief by taking nitrates.
• Do not qualify as a candidate for invasive procedures (bypass surgery, angioplasty, or stenting.

Published studies conducted at numerous medical centers have demonstrated benefits for most patients including:

• Less need for anti-anginal medication
• Decrease in symptoms of angina
• Increased ability to do activities without onset of symptoms
• Ability to return to enjoyable activities

Reviewed by the doctors at The Cleveland Clinic Heart Center.