Enhanced external counterpulsation (EECP) is a therapy for treating angina and congestive heart failure. It offers hope to those with advanced coronary artery disease who can’t undergo bypass surgery. Here's how it works...
The physiology of EECP is similar to that of the intra-aortic balloon pump and mast pants, more familiar emergency medical devices that have been in use for many years. The balloon pump is an invasive device that inflates inside the aorta during the diastolic phase of the heartbeat to increase circulation back to the struggling heart in intensive care situations. Paramedics use mast pants on patients to control bleeding and raise blood pressure after trauma-shock situations.
EECP Sort of Combines the Two
Also a noninvasive procedure, EECP involves a pair of inflatable pants that surround your lower extremities and are covered in rigid steel cylinders. When the heart is relaxing in the phase that physicians call diastole, a cuff inflates, which increases the pressure in your aorta, encouraging more blood to back fill your coronary arteries, stretching them as they fill. [Your arteries actually originate right off of your aorta as it emerges from the left ventricle.]
The machine includes three pressure bladders sewn inside five cuffs that are timed to inflate in synch with your heartbeat. Two cuffs surround each calf, two on each thigh, and the last set on the buttocks.
There are sensors to detect your heart rhythm and your blood oxygen level, and the machine makes a thumping, sort of rushed-air sound as the cycle starts from your calves up toward your heart. As the computer senses an oncoming heartbeat, the cuffs are deflated, acting as a vacuum to make it easier for your heart to pump out the next contraction.
Mechanically, as more blood flow is milked back into coronary circulation, oxygen-rich blood is distributed to vital heart muscle, decreasing what cardiologists call “afterload,” or the work assumed by the heart during the relaxation stage in between heartbeats. When this happens, there is temporarily better oxygen utilization in the heart muscle.
According to physicians who use EECP, the arteries are gently stretched, just like squeezing a long balloon, and this process promotes the development of collateral circulation.
(It was noted during angiography that some people develop collateral circulation—their own new blood vessels that grew around an area of blockage to get the blood through to the heart muscle. So, EECP is a way to help a person’s body to perform its own “bypass” to restore blood flow to areas in need.)
For more on EECP, including a site locator, visit www.vasomedical.com. For you smartphone techies, Vasomedical even has an iPhone application where you can check out patient selection information, clinical guidelines, and treatment tools.
The protocol is five days a week for seven weeks, and the sessions last three to four hours.
Now it's your turn: Have you, or someone you know, been helped by EECP?
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