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Enhanced External Counter Pulsation (EECP)

Do any of these conditions apply to you?

  • Suffer from Coronary Artery Disease
  • Suffer from Angina
  • Suffer from Congestive Heart Failure
  • No Longer Respond to Your Medication
  • Have had Repeat Cardiac Procedures (bypass, stents, angioplasty)
  • Unwilling to Undergo Invasive Surgery
  • Unable to Undergo Invasive Surgery

Did You Know That

Heart disease and its consequences remains the number one killer in America. 13 million Americans suffer from heart disease. Fortunately, for most people suffering from heart disease and other systemic circulatory conditions, there is an alternative that is significantly less invasive and has been proven over and over again to be just as effective and if not, even more effective than the other more invasive procedures. This treatment is called Enhanced External Counter Pulsation (EECP).

History and Background

EECP has been around since the 1950’s with research in counter pulsation being done at Harvard University. In the United Sates alone there are about 700 EECP units. It is approved by the FDA, and has been for almost 15 years, for the treatment of chronic stable angina, cardiogenic shock as well as during a heart attack. It is now additionally used as a treatment for several heart and circulatory conditions such as peripheral vascular disease, coronary artery disease, angina, as well as congestive heart failure. There are more than one hundred peer reviewed studies that show EECP’s effectiveness. In fact it has been shown to be at least as effective, if not, more effective than angioplasty, without the invasive surgery. It has been proven to be extremely effective and safe. There have been many multicenter, controlled, clinical studies conducted throughout the United States, India and China. At present EECP is being studied and used at many prestigious medical centers such as Rochester Medical Center, Heart Centers of America, University of California at San Francisco, Mayo Clinic, Harvard University and literally dozens of other medical centers throughout the United States and around the world.

EECP is a safe, non-invasive medical procedure used to correct peripheral circulatory disease and coronary artery disease. EECP works by increasing blood circulation to the heart and the rest of the body. It is a simple in-office procedure that is given daily, five times per week for seven weeks, at one hour per treatment (a total of 35 hours). There is no down time. The treatment consists of strapping blood pressure-type inflatable cuffs to the lower legs and thighs while the patient lies on the treatment table. During the relaxation phase of the heartbeat, the cuffs quickly inflate in sequential order from the lower legs to the upper thighs and buttocks. This causes counter flow of blood back through circulation and to the heart.

What Causes Heart Disease

Our understanding of heart disease has increased in the last several years. Once thought to simply be a ‘plumbing’ problem, we now know that heart disease is much more than this. In fact, heart disease is not simply a disease of ‘blockages’ of the arteries of the heart (atherosclerosis) due to the build up of cholesterol inside the arteries. Only half of those who have a heart attack have elevated cholesterol. According to the New England Journal of Medicine (2002), C-reactive protein (CRP), a measure of inflammation, is a better predictor of heart attack than cholesterol. The condition is a systemic one. You can be certain that if an individual has blockages in their heart, it is very likely that they will also have blockages in other parts of the body. Secondly, cholesterol is not the underlying cause of these blockages. There are several steps in the development of an arterial plaque. Simply stated heart disease begins with damage to the inner lining of the arteries. This damage can be mechanical, which can be caused by elevated blood pressure, chemical, as in smoking and uptake of other toxic chemicals, infection, elevated free radicals, and others. The result of this damage is inflammation. The inflammatory response is the response of the body as it attempts to ‘fix’ the damage. Besides inflammatory white blood cells, oxidized cholesterol, calcium and platelets deposit in the area to further aid in repair. Over time a fibrous sheath is laid down over the plaque to wall of this damaged site. Over many years the plaque grows larger and larger progressively blocking blood flow through the artery. Arteries can be blocked in the range of 70% before an individual may feel any symptoms at all. Further, when the plaque becomes weak over time, a piece of inflammed, fatty plaque “erupts” from the artery wall. Upon rupture, the internal lining ‘bleeds’. Platelets stick together at the site of rupture, forming a thrombus (blood clot). This is the clot that we know to ‘block’ the artery. The block and subsequent decrease in blood flow, is the cause of angina and in other cases myocardial infarction (heart attack). Traditionally, coronary bypass surgery, stents and angioplasty have been the treatments of choice for this situation. Almost 2 million of these procedures are performed annually. Though some benefits of these procedures are obvious, they do not treat the underlying cause and are very invasive and therefore do carry significant risk.

How Does EECP Work

EECP works in two major ways:

During EECP therapy blood pressure type cuffs are placed around the calves, thighs and buttocks. As your heart enters its relaxation phase of the heartbeat (diastole) the cuffs sequentially inflate from the lower legs to buttocks, to a pressure of 260 mmHg. This action increases the blood flow back to the heart by 28%. The counter pulsation of blood to the heart increases the strength of contraction of the heart and therefore cardiac output. As the cuff pressure increases so too does the volume of blood to the heart and thus cardiac output even further. It is a linear relationship. This also increases and strengthens circulation throughout the body. As you can imagine the increase in blood flow through circulation will increase the delivery of oxygen and nutrients to the heart muscle and throughout the body.

As the heart enters the contraction phase of the heartbeat (systole), the cuffs quickly deflate, decreasing the resistance of blood circulation through the body. This helps to decrease the workload of the heart. In short, EECP therapy increases blood flow to the heart muscle. Some compare EECP therapy to passive exercise for the heart.

Secondly, our bodies have the natural ability to develop newly functioning arteries. Each person has small arteries that are not contributing to regular blood flow because they are not needed. However when there is a blockage in an area these non-functional arteries will “develop” around the block to ensure oxygen and nutrients to the area. This process is referred to as collateral anastomosis. The force against the lining (endothelial) of the arteries created by EECP increases the production of vascular endothelial growth factor (VEGF), a chemical that stimulates new blood vessels to grow and mature. VEGF is increased by 21% following a single 60 minute treatment.

EECP therapy further decreases pro-inflammatory white blood cells and promotes dilation and relaxation of the arteries through production of nitric oxide. Nitric oxide also strengthens the inner lining of arteries thereby protecting them from damage. EECP also decreases a chemical called endothelin. This chemical has several damaging effects on cardiac health. First, it causes constriction of blood vessels and therefore decreased blood flow. This causes the heart to work harder in order to overcome the increased vascular resistance. Endothelin also causes an increase in blood pressure since it increases aldosterone and atrial natriuretic peptide which both cause salt retention and therefore water retention. This of course is a very important cause of congestive heart failure and major risk factor for a heart attack.

The clinical outcomes show a reduction or elimination of angina, reduced nitroglycerine use, greater exercise tolerance, more energy, increased libido, and better emotional outlook.

Nobody has ever died as a consequence of this procedure. Other than mechanical wear and tear on a persons legs, there has not been any serious complications or adverse effects from the treatment. It does not cause stroke or induce heart attacks. As noted above, EECP has been FDA approved for use during a heart attack.

Contraindications

Almost every person is a candidate for EECP. However there are a few exceptions. Some of the contraindications are relative (case by case) and not absolute. Before EECP therapy is prescribed, a case history, physical exam and special testing are required to determine a persons candidacy for treatment. The following are contraindication and relative contraindications to EECP therapy:

  • Pregnancy
  • Uncontrolled hypertension (above 180/110)
  • Severe aortic insufficiency
  • Abdominal aortic aneurysm
  • Individuals with current blood clot in the deep veins of the leg (DVT).
  • Phlebitis (relative)
  • Open wound (relative)
  • Bleeding disorders (relative)
  • Fever (relative)

Even though this remarkable treatment has been around for decades and used throughout the world, it is not well known in Canada. In fact, in Canada, EECP is only available in Ottawa, Toronto, Brampton, and now Kamloops. Yes, we are the only clinic west of Toronto who offers EECP therapy.

I strongly suggest you read the following book by Debra Braverman called: Heal Your Heart with EECP.
It is an excellent resource book that outlines the full history of EECP, its applications, effects, indications and contraindications. You can also visit: www.vasomedical.com . They manufacture the EECP units and their web site has many references and resources.