Frequently Asked Questions
EECP is the first nonsurgical, non-pharmaceutical, mechanical treatment for patients with chest pain and heart failure. It helps to increase blood flow to the heart muscles deprived of adequate blood supply. The beneficial effect obtained after the completion of treatment persists for years together. Thus any need for surgery is totally avoided/need for intervention reduced.
You may be a candidate if:
You have chest pain / shortness of breath
Your medical treatments not able to relieve your cardiac symptoms.
You have already had a cardiac surgery and symptoms have returned
Your physician has informed you that you cannot undergo bypass surgery or Angioplasty
You are not willing to undergo invasive Bypass surgery / Angioplasty
Despite the advances in cardiology in treating chest pain and heart failure, the problem still persists. Drugs do not always provide relief and invasive procedures have their own associated risk factors. EECP can provide the patients with all the advantage similar to that of medication. Further, symptom relief upon EECP usage is comparable to that of invasive procedures without undergoing them.
In an EECP session, the patient lies on a padded table. Three large inflatable cuffs, similar to blood pressure cuffs, are strapped around the calves, lower thighs, upper thighs and buttocks. The patients heart beat is monitored by an electrocardiograph display in the machine, which through the computer regulates the inflation and deflation of the cuffs. During the part of the cardiac cycle when the heart is at rest (diastole), the cuffs are rapidly inflated in sequential order beginning with the cuffs at the calves and working upward. Just before systole (heart contraction), the cuffs are simultaneously deflated.
The treatment is delivered for a period of 35 hours. This period is broken into every day one hour periods spread over five days a week.
EECP involves 35 days of treatment. Each treatment session is for one hour and the patients are asked to come six days a week for six weeks. It is very important that the patients adhere to the one-hour time schedule fixed by the hospital or medical center and that the treatment is continued without a break.
EECP helps to relieve angina by promoting collateral circulation.
Formation of network of tiny blood vessels, which make it possible for blood to detour around blocked or narrow arteries, is called collateral circulation. However, the development of collateral circulation is a gradual process and not everyone has the same ability to develop these networks at the rate that will relieve angina. EECP treatment triggers and accelerates this collateral circulation and makes it permanent.
EECP increases the blood flow to the heart muscles. The increase in blood flow to the area of heart muscle not receiving enough blood supply is achieved by two means by EECP treatment (1) Forming new vessels around the blocked artery. (2) Because of increase blood flow and pressure during EECP there is high pressure in open coronary arteries and lower pressure in closed arteries. Blood finds its way to the low pressure zone or area, which has decreased blood supply by opening the collaterals. These collaterals eventually become permanent.
Three sets of cuffs in lower limbs inflate sequentially from distal to proximal one by one and then all cuffs deflate simultaneously for every cardiac cycle
EECP Enhances coronary collateral circulation (opening and enlarging normally closed arteries when there is blockade thereby creating alternative route of blood supply to heart muscle)
EECP treatment is painless and comfortable.
The treatment is like a ‘Passive Exercise’, without increasing your blood pressure and heart rate. There is a feeling of rhythmic pressure from the cuffs around your legs and buttocks. Usually, patients can watch TV or listen to music when the session is being delivered. It is not abnormal to feel tired after the first few sessions. But this will pass as the number of sessions increase.
Whether it is bypass surgery or angioplasty, the basic idea is to increase the blood flow to the area of the heart muscle not receiving adequate blood supply. Once the blood supply is increased towards normal, the patients chest pain will be decreased or eliminated and his or her exercise tolerance will improve.
In bypass surgery, the diseased section of your coronary artery is bypassed with a healthy artery or vein to increase the blood flow to the heart muscle area. Once the blood flow is restored, chest pain may be reduced or eliminated.
In angioplasty an inflatable balloon is introduced inside the obstructed coronary artery and the balloon is inflated once it is positioned inside the artery. The obstructed part is pressed against the vessel wall and the blood flow is restored.
During EECP, the heart muscle’s natural mechanism of forming new vessel is enhanced, which markedly increase the blood supply to the heart muscle. EECP also tends to improve the endothelial cell function that lines your coronary arteries, which determine the chance of getting heart attacks. EECP also decreases the heart rate and other deleterious Neurohomones, which damage the heart muscles.
Patient can walk more distance without chest pain
Patient would have fewer or no angina
Episodes of angina would be less painful
Patient need for anti-anginal medications can be reduced
Patient can return to work and can participate in their active life style once again
Patient would be more energetic and confidence
Some patients want to visualize the post-EECP treatment improvement, when compared with their previous reports. They can repeat their Exercise treadmill test or Echo Cardiography or Nuclear scan after the treatment. Some physicians might feel follow-up tests are unnecessary, since the patient symptomatic clinical improvement itself has demonstrated increase blood flow to the heart muscle.
EECP is a safe, outpatient, non-invasive treatment. Hence, individuals dont have to restrict any of their daily routine work. The one-hour time treatment schedule can be fixed according to the patient’s convenience. Before the treatment is started, the patient is asked to wear tight fitting elastic pants. This is to prevent skin irritation and abrasion during the inflation and deflation of the cuffs. Some basic precautions include
Avoid taking food two hours before the treatment.
Empty your bladder before starting the treatment.
If you are taking any diuretic medication avoid taking them before the treatment.
Continue your regular medication as prescribed by your physician.
EECP is not considered a replacement for coronary artery bypass surgery or balloon angioplasty. Instead EECP may delay the need for these invasive procedures. In many cases, relief will be sufficient to render them unnecessary. EECP is also used in patients who have already undergone surgery or angioplasty but not getting sufficient relief of their symptoms.
To prevent the progression of the heart disease, after completion of the EECP treatment, the patient should make life style changes like
Following a heart-friendly diet
Doing regular exercise.
Have regular follow-up with your cardiologist to lower your cholesterol, to control your blood pressure and diabetes. EECP treatment provides an accelerated means to develop new blood vessels.
Each patient responds differently. Most patients begin to feel the improvement after about 15 to 20 sessions. The usual feeling of increase in energy level is experienced about halfway through the six week session.
Patients as young as thirty and as old as ninety-five have successfully completed EECP without any complications. Many of our patients, in spite of their advance age having shown excellent results.
Occasionally, patients develop mild skin irritation and sometimes minor abrasion in the areas under the treatment cuffs or experience muscle or joint discomfort. Rarely, patients develop shortness of breath requiring immediate medical attention and hospitalization. Your EECP therapist and supervising doctors are trained to make your treatments safe and to minimize risk.
Having your EECP therapy each day of the six-week treatment course is an important part of receiving the greatest benefit. You are advised to take the treatment without frequent interruption. Missed treatments are usually made up so you receive all 35 hours.
Most of the patients undergoing EECP have blockages in their coronary vessels that are hard and stable. The increase in blood flow caused by EECP treatment is safe and the blood just detours bypassing this obstruction through the newly formed pathway. Hence, this treatment is otherwise also called Natural Bypass. During the 35 days of treatment, the new pathway due to continuous blood flow will become permanent. No patient had reported heart attack or stroke due to any dislodged plaques.
Yes. Pacemakers and defibrillators do not interfere in any way with EECP treatment.
Yes. Many of the patients with Bypass surgery / Angioplasty or Stent may develop cardiac symptoms either due to bypass graft getting occluded or stent getting blocked again or new blockage appearing in the coronary vessels, which were normal before. EECP treatment will be the only option for them to improve their blood flow to the heart muscle without risk of repeat interventional procedures.
No. You can manage your blood pressure by simple medication and then you can undergo EECP. Patients with hypertension have shown to benefit by having better control over their blood pressure and also significant fall in their blood pressure after a course of EECP treatment.
Yes. EECP treatment has shown improvement in blood sugar control in patients with a diabetic condition, similar to what is achieved by aggressive exercise. The additional advantage is that it is achieved in a shorter time duration.
No. Varicose veins do not interfere in applying pressure in the leg during EECP treatment. Your EECP therapist will provide comfortable padding to ensure maximum comfort.
Yes. Irregular heart beat or atrial fibrillation, which causes irregular heartbeat, will not interfere with the benefits achieved by EECP treatment. Your physician might advise certain drugs during treatment, if your heart rate is greater than 100 beats per minutes.
Yes you can. EECP improves blood flow throughout your body, including your legs. If you have poor leg circulation due to blood vessel blockage in your leg artery, you might need more than 35 treatments to get full benefit of the treatment. In addition to improved cardiac symptoms peripheral vascular disease patients also will have a marked improvement in their leg circulation in response to EECP.
Few patients with medical conditions like enlarged (aneurysm) aorta, which needs surgical repair, and patient with severe bleeding disorders cannot undergo EECP treatment. Otherwise, EECP is safe for all other patients.
Yes. You can repeat the EECP treatment again if your symptoms return. Since the treatment is non-invasive, and similar to a passive exercise, it can be repeated without any risk. Heart disease is a chronic progressive illness and no treatment for heart disease is once in your lifetime treatment.
Your doctor will discuss an exercise program based on your heart condition. Usually, you will be asked to begin exercises after 15 sessions of EECP treatment. Exercising during EECP will enhance the treatment effect and continuing exercise after treatment will help you to maintain the benefits achieved.
EECP has numerous distinct advantages over surgery:
No additional medication required
No side effect
Patients have reported increased exercise tolerance energy and free from chest pain following treatment without risk of surgery.