External Counterpulsation (ECP) is a non-invasive, outpatient treatment designed to improve blood flow, particularly to the heart. It enhances circulation without surgery or hospital stays. This therapy is often considered for individuals seeking to improve their heart health and overall circulatory function.
Understanding External Counterpulsation
ECP works by using inflatable cuffs placed around the calves, thighs, and buttocks. These cuffs are connected to a machine that inflates and deflates them in synchronization with the patient’s heartbeat, monitored by an electrocardiogram (ECG). During the heart’s resting phase, the cuffs rapidly inflate in a sequential manner, starting from the calves and moving upwards towards the buttocks. This inflation pushes blood from the lower limbs back towards the heart, increasing blood flow to the coronary arteries and augmenting diastolic pressure.
Just before the heart pumps blood, the cuffs rapidly deflate. This creates a brief vacuum effect, which reduces the resistance the heart has to pump against, decreasing its workload and improving its efficiency. The rhythmic inflation and deflation enhances oxygen-rich blood supply to the heart muscle and other organs, while also reducing the strain on the heart. Over time, this process is believed to encourage the development of new, small blood vessels, sometimes called “natural bypass,” and to improve the function of existing blood vessels.
Conditions Treated and Benefits
ECP is primarily used for individuals experiencing chronic stable angina, which is chest pain indicating the heart muscle is not receiving enough oxygen-rich blood. It is considered for patients whose angina does not respond to other treatments, who are not candidates for surgical procedures like bypass surgery or angioplasty, or who continue to have symptoms after such treatments. The therapy has also shown benefits for patients with congestive heart failure.
Patients undergoing ECP often experience a reduction in angina symptoms and improved exercise tolerance, allowing them to be more physically active. This leads to an enhanced quality of life and a reduced need for nitroglycerin. Studies have shown that these benefits can last for several months to a few years, with some patients sustaining improvements for up to five years.
The ECP Procedure
An ECP session involves the patient lying on a padded table. Inflatable cuffs are wrapped around the patient’s calves, lower thighs, and upper thighs/buttocks. An electrocardiogram (ECG) monitors heart rhythm, ensuring the cuffs inflate and deflate in synchronization with each heartbeat.
Each session lasts about one hour. A full course of ECP treatment consists of 35 sessions, administered five days a week over seven weeks. During the procedure, patients describe the sensation as a rhythmic pressure, similar to a massage. It is well-tolerated, allowing patients to return to their routine immediately after each session.
Who Can and Cannot Undergo ECP?
ECP is recommended for individuals with chronic stable angina (Class III or IV by the Canadian Cardiovascular Society), especially those who are not suitable for revascularization procedures or who have persistent symptoms after interventions like angioplasty or bypass surgery. Patients who prefer non-surgical alternatives are also considered.
Contraindications for ECP include severe aortic insufficiency, significant peripheral artery disease, and uncontrolled high blood pressure (systolic over 160 mmHg or diastolic over 100 mmHg). Other contraindications are hypertrophic cardiomyopathy, certain valvular heart diseases, an enlarged heart, or a pacemaker. While generally safe, some minor and temporary side effects can occur, such as mild discomfort, skin irritation, or pressure sores at the cuff sites, dizziness, fatigue, or muscle aches.