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Enhanced External Counterpulsation (EECP)

A patient’s guide to Enhanced External Counterpulsation If you suffer from chronic angina pectoris, your physician may consider you a candidate for EECP (Enhanced External Counterpulsation), a noninvasive treatment for patients. This article is designed as an introduction to EECP and its possible benefits. Your physician will be able to answer any additional questions you may have about this treatment.

How your heart works

Your heart is basically a hollow muscular organ consisting of two pumps. Each pump (one on the left and one on the right) is divided into two chambers that are linked by passageways in which there are valves to ensure that the blood flows only in one direction. The left ventricle, which must pump blood out into the body through a large blood vessel (the aorta), is the chamber of the heart that works hardest, and; therefore, has the greatest need for oxygenated blood.

The blood’s cycle through your heart begins when oxygen-depleted blood returns to the heart, entering the right upper chamber (atrium) via the largest veins, called the venae cavae. From the right atrium, blood passes through a valve to the right lower chamber (ventricle). It is then pumped through the pulmonary artery into the lungs where it receives oxygen.

This freshly oxygenated blood then flows through the pulmonary veins into the left atrium and then into the left ventricle. From the left ventricle, blood is pumped through the aorta out into your body again.

Why treatment with EEP may benefit patients with angina pectoris.

Your heart pumps blood throughout your entire body to supply tissues with the oxygen and other nutrients they need. In order to do this, the heart itself needs oxygen-enriched blood to generate the energy it requires. Because the heart muscle is unable to obtain this energy directly from the blood it pumps, it relies upon its own set of blood vessels – the coronary arteries – for oxygen-enriched blood.

The coronary arteries are distinct from other arteries in the body in that maximal blood flow occurs during diastole (when the heart is relaxing) while other arteries receive most of their blood supply during systole (when the heart is contracting). This is because when the heart contracts, the coronary vessels are squeezed and cannot carry enough blood at that time.

In some people, the coronary arteries can become narrowed or obstructed so that during exercise or stressful situations, an insufficient amount of oxygen-enriched blood is able to reach some parts of the heart muscle. Often, the result is a painful experience called angina pectoris.

What is Enhanced External Counterpulsation?

EECP is a nonsurgical, mechanical procedure that can reduce the symptoms of angina pectoris, presumably by increasing coronary blood flow in ischemic areas of the heart. The beneficical effects of EECP in patients with coronary artery disease appear to be sustained between treatments and may persist long after completion of a course of therapy.

What does EECP procedure include?

While EECP is performed, you will be lying on a bed wearing a series of pressure cuffs (like large blood pressure cuffs) around your calves, lower thighs, and upper thighs.

The EECP system includes a pressure source that inflates and deflates these cuffs. The pressure moves the blood from your lower limbs toward the heart. The vascular networks in the large muscles of our legs are compressed in sequence, progressing from the calves upward. Each wave of pressure is electronically synchronized with your heartbeat via an electrocardiographic signal, so that the increased blood flow is delivered to your heart at the precise moment it is relaxing and blood flow through the coronary vessels is at its peak. When the heart pumps again, the pressure in the cuffs is withdrawn and the cuffs are deflated instantaneously. This lowers resistance in the vascular bed of your legs so that blood may be pumped more easily from the heart.

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