CANM Completes EECP (Enhanced External Counterpulsation) Patient #100!
02/18/2005.
Cardiology Associates of North Mississippi recently completed patient #100 with the EECP program in Tupelo. Enhanced External Counterpulsation (EECP) is a treatment for refractory angina, which is not responsive to medical therapy and not readily amenable to angioplasty or bypass.
Results of clinical trials show that EECP is a safe and effective choice for people who are considered at high risk for bypass surgery and angioplasty. The procedure is administered in an outpatient setting, does not require any surgery or anesthetic, and is relatively comfortable for patients.
When applied over time, EECP can reduce the frequency of angina episodes, improve exercise capacity, and may even reduce the need for medications. EECP is not meant to replace bypass surgery or angioplasty, but is an additional treatment for those patients who can no longer benefit from additional surgery or angioplasty.
EECP enhances blood flow to the heart and coronary arteries by squeezing blood out of the lower parts of the body up towards the heart. Sometimes referred to as a “natural bypass,” EECP stimulates the growth of new blood vessels around blocked arteries.
While EECP is performed, the patient is lying on a special treatment table wrapped in three sets of cuffs (like large blood pressure cuffs) around the calves, lower thighs and upper thighs (including the buttocks). The EECP treatment system includes an air compressor that inflates and deflates these cuffs, starting with the calf cuffs, then the lower thigh cuffs, and then the cuffs at the upper thigh and buttocks. The pressure moves the blood from the lower limbs toward the heart. Each wave of pressure is timed to the heartbeat so that the increased blood flow is delivered to the heart at the time that it is relaxed and blood flow to the heart arteries is at its peak. When the heart pumps again, all the cuffs deflate at the same time. This lowers the resistance in the blood vessels of the legs, and decreases the amount of work for the heart to pump blood to the body.
The initial course of EECP therapy involves 35 consecutive one-hour sessions, once or twice each day, for approximately 7 weeks. EECP can benefit the heart in two ways: First, the pumping action of the leg cuffs increases the blood flow to the coronary arteries. Because the coronary arteries receive blood from the heart after each heartbeat, the inflation of the cuffs helps more blood flow into the coronary arteries with each heartbeat.
Second, just as the heart begins to beat, EECP deflates the cuffs and creates a vacuum-like action in the arteries. This reduces the work of your heart muscle in pumping blood into the arteries.
Based on the results of clinical trials, therapy with EECP can help relieve symptoms of angina, reduce the need for angina medications, and reduce the frequency and intensity of chest pain. The procedure can also increase a patient’s ability to exercise and give them more independence in daily activities.
Because EECP helps reduce the frequency and intensity of chest pain for the short and long-term, many people who undergo treatment experience an improved sense of well-being and overall improvement in their quality of life.
Since individual conditions differ, there is no specific time when one might expect to feel better. Most people experience some improvement after 10-12 sessions. Others require a longer period of time to notice a difference in their angina symptoms.
Published reports have found that EECP is a relatively safe and effective option for certain people with angina. The Multicenter Study of Enhanced External Counterpulsation (MUST-EECP) randomly assigned 139 people with angina from seven US hospitals to receive either active EECP or a placebo (inactive) procedure for 35 hours over four to seven weeks.
About two-thirds of the people receiving EECP benefited from the treatment. Compared with the people who re ceived the placebo procedure, those who completed the active EECP sessions had significantly less angina and tended to need less nitroglycerin. Also, people who received the active EECP were able to exercise longer before experiencing chest pain. Ten people dropped out of the study because of adverse events – half of them because of leg pain or chafing. The study was published in the June 1999 issue of the Journal of the American College of Cardiology.
EECP appears to have both short-term and long-term benefits. A study published in the April 2000 issue of Clinical Cardiology reported results in 33 patients with coronary heart disease who received EECP. After five years, 64 percent did not need bypass surgery or balloon angioplasty and did not have a major adverse cardiovascular event. This rate is similar to that found in many people who are treated with bypass surgery or angioplasty.
A more recent study showed that the procedure relieves angina and improves perfusion (blood flow to the heart) during stress in patients with coronary artery disease. The research was published in the April 1, 2002 issue of the American Journal of Cardiology.
Researchers are uncertain exactly how EECP helps ease angina. The procedure may stimulate the growth of tiny blood vessels in the heart and help bypass blocked blood vessels. This would increase blood flow and oxygen to deprived areas of the heart. EECP may also improve the function of existing blood vessels. The EECP procedure is repeatable if patients do develop recurrent angina.
EECP should not be used for the treatment of patients with, or who develop the following disorders during the course of treatment with EECP:
- Uncontrolled congestive heart failure
- Severe heart valve disease
- Uncontrolled arrhythmia
- Hemorrhage
- Coagulopathy (a condition where the blood doesn’t clot adequately)
- Inflammation and blood clots in the veins in the legs, or poor circulation to the legs
Patients with blood pressure higher than 180/110 mm Hg or a heart rate of more than 120 beats per minute should have these conditions brought under control before treatment begins.
The most common side effects are mild headache, mild dizziness, fatigue or muscle aches. A small number of people develop pressure sores, skin irritation or bruising from the cuff inflation.