Treating Chronic Angina With ECP
10/01/2003.
Many patients with obstructive coronary artery disease cannot get angina relief through standard angina treatments, including medical therapy, stent implantation, and CABG. For these people, a new procedure, called external counterpulsation (ECP), may stimulate the formation of collaterals (small branches of blood vessels) to create a natural bypass around the narrowed or blocked arteries responsible for angina, and thereby provide needed relief from anginal symptoms.
The ECP treatment firmly compresses the blood vessels in the lower limbs and pelvis to increase blood flow to the heart. Each wave of pressure is electronically timed to the heartbeat, so that the increased blood flow is delivered to the heart during diastole (at the precise moment the coronaries are filling). When the heart pumps again, pressure is released instantaneously. This lowers resistance in the blood vessels in the legs so that blood may be pumped more easily from your heart. The overall action is similar to that of an intra-aortic balloon pump.
ECP may encourage blood vessels to open small channels that become extra branches. These channels or collaterals may eventually become “natural bypass” vessels to provide blood flow to the heart muscle. This contributes to the relief of angina symptoms. Nuclear imaging studies before and after ECP have documented the improvement in myocardial perfusion.
During treatment:
- Patients lie down on a padded table in a treatment room.
- Three electrodes are applied to the skin of the chest and connected to an electrocardiograph (EKG). The EKG will display the heart’s rhythm during treatment. Blood pressure is also monitored.
- A set of cuffs is wrapped around the calves, thighs and buttocks. These cuffs attach to air hoses that connect to valves that inflate and deflate the cuffs. Patients experience a sensation of a strong “hug” moving upward from calves to thighs to buttocks during inflation followed by the rapid release of pressure on deflation. Inflation and deflation are electronically synchronized with the heartbeat and blood pressures.
Patients who are accepted for treatment must undergo 35 hours of ECP therapy. Treatment is administered as an outpatient in the clinic one to two hours a day, five days a week, until the 35 hours are completed. Most patients note improvement in symptoms after two weeks of therapy.
Patients that are candidates for ECP:
- Have chronic stable angina.
- Are not receiving adequate relief by taking nitrates.
- Do not qualify as a candidate for invasive procedures.
Cardiology Associates of North Mississippi is the only provider offering this therapy in North Mississippi. To receive more information on ECP, or to schedule a patient for the procedure, call Cardiology Associates at 662-620-6800.