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Enhanced External Counterpulsation Frequently Asked Questions (FAQ)

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I have already had bypass surgery/angioplasty/stents. Can I still have EECP ?

Yes. The majority of our patients on EECP therapy have already had coronary angioplasty with stents (PCI) and/or CABG surgery. These patients received EECP therapy because of recurrent angina pectoris or similar symptoms, despite optimal medical therapy and/or revascularization.


How long do the clinical effects of EECP last?


The clinical benefits of EECP extend beyond the time period of any acute hemodynamic beneficial effects. For example, the patients treated with EECP in the Multicenter Study of Enhanced External Counterpulsation reported a reduction in angina episodes and decrease in nitrate use beyond the duration of therapy.

It is not fully understood why, after the EECP therapy is completed, patients remain improved, and the clinical benefits of the treatment persist for several years.

How much pressure is applied during inflation?

The pressure applied to the pneumatic cuffs during sequential inflation—from calves to thighs to buttocks—is 4-6 pounds per square inch (psi), which is the equivalent to 206 to 360 mmHg.  This produces a light squeezing sensation against the legs, similar to a massage.


Can a patient with atrial fibrillation have EECP therapy?


Uncontrolled atrial fibrillation, atrial flutter, and frequent PVCs may interfere with the triggering of the EECP system.  The average beats should be of 50-100/min. However, if the heart rate is controlled and no faster than 100 bpm, atrial fibrillation will not interfere with EECP.

Patients with frequent and irregular heartbeats with high heart rate (HR) >100 or low HR <50 should delay EECP until rate control has been achieved.

Can a patient with varicose veins have EECP?

Yes. Varicose veins do not preclude individuals from receiving EECP.  We often use extra padding in patients with varicose veins to ensure maximum comfort.  If a diagnosis of deep vein thrombosis is entertained, however, a venous US Doppler study of the lower extremities should be performed in advance of EECP therapy.

Can a patient with peripheral artery disease have EECP?

Yes. EECP improves blood flow throughout the entire body, including the lower extremities. In our experience, patients with this condition—if not severe—may require more than 35 EECP sessions to obtain the full benefit of the therapy. We have documented (with arterial Doppler studies) the circulation of the lower extremities before and after EECP in some patients with diabetes, with marked improvement in response to EECP.

Does EECP aggravate high blood pressure (hypertension)?

No.  As a matter of fact, EECP has a therapeutic role in the management of arterial hypertension and hypertensive heart disease.  If you have hypertension that is properly managed, you may undergo EECP without difficulty.  Oftentimes, patients with hypertension find that their blood pressure improves as they proceed with EECP.

If your hypertension is uncontrolled, you must seek medical care to get your blood pressure under control with proper medications before proceeding with EECP.


Is there an age limit for EECP?

No. We have successfully treated patients as young as 35 and as old as 86 without any difficulties. Many of our patients are in their 80s, and complete the entire EECP program with excellent results.

Can EECP dislodge plaque and cause a stroke or heart attack?

No.  Atherosclerotic plaques are calcified and hard, and they create an obstruction that detours the blood through alternate routes of least resistance. During EECP, when blood is flowing to your heart, it will naturally bypass arteries with significant plaque and enter healthy, non-diseased blood vessels to go around the blockages. In time, these new pathways are reinforced and become lasting routes for blood to reach your heart beyond the blockages. This is why EECP is often called the “natural bypass.”

What happens if a patient misses an EECP session?

Missing a day of EECP therapy will not have a negative effect on the overall treatment.  As with any other therapy, you are encouraged to attend all prescribed appointments. The more consistent you are with the EECP schedule, the better the results will be.  The missed session will be added to the end of your program until you have a total of 35 sessions.

Besides angina, is EECP useful for other non-cardiac conditions?

In our experience, EECP has been useful for other non-cardiac conditions such as erectile dysfunction, renal failure with fluid retention refractory to diuretics, and obesity-associated with fluid retention as well.

EECP has also proven to have a therapeutic role in the treatment of restless leg syndrome, hepatorenal syndrome, erectile dysfunction, syndrome X, and retinal artery occlusion.

Why is EECP an underutilized therapy in patients with refractory AP?

Most practicing cardiologists today don’t have hands-on experience with this modality.  Many of the university medical centers that train cardiology fellows don’t have an EECP program. There are some logistic problems involved as well. For example, if you live in Anaheim and there is an EECP program at Cedars Sinai Medical Center in Los Angeles, you will spend about 2-4 hours traveling to and from this Medical Center for one hour of therapy every day for 35 days.

Lack of exposure to EECP and interrupted follow-ups of these patients with refractory angina pectoris discount the opportunity to see how much of a difference EECP can make in reducing symptoms and improving quality of life of these patients.  What is more, there exists at present a lack of genuine interest by academia and other associated industries to support new randomized clinical trials.  Finally, to make things worse, there are cardiologists who would like to see “more solid clinical data” to continue practicing “evidence-based medicine.”

Results speak for themselves, however.  The health, happiness, and quality of life of our patients consistently improve following EECP treatment, and this, above all, is our primary concern.

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