Enhanced External Counterpulsation (EECP)

 Enhanced External Counterpulsation (EECP)

Definition

Enhanced External Counterpulsation (EECP) is a non-invasive treatment for patients with angina pectoris, heart failure, and other cardiac conditions. It improves blood flow to the heart and other parts of the body by using external cuffs to compress the lower limbs in sync with the cardiac cycle.

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Mechanism of Action

1. Cuff Inflation:

   • During diastole, pneumatic cuffs around the lower legs, thighs, and buttocks inflate sequentially from the distal to the proximal segments.

   • This increases diastolic pressure, enhancing coronary perfusion.

2. Cuff Deflation:

   • Just before systole, the cuffs deflate rapidly, reducing vascular resistance and decreasing the workload on the heart.

   • This improves cardiac output and reduces afterload.

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Indications

1. Chronic Stable Angina:

   • For patients not responding to medication or not candidates for invasive procedures.

2. Heart Failure:

   • In patients with reduced ejection fraction.

3. Peripheral Artery Disease (PAD):

   • To enhance blood flow and relieve symptoms.

4. Other Uses:

   • Post-myocardial infarction rehabilitation.

   • For improving exercise tolerance and quality of life in selected cases.

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Contraindications

1. Absolute Contraindications:

   • Severe aortic regurgitation

   • Deep vein thrombosis (DVT)

   • Severe peripheral vascular disease

   • Uncontrolled hypertension (>180/110 mmHg)

2. Relative Contraindications:

   • Pregnancy

   • Recent vascular grafts or bypass surgery

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Procedure

1. Preparation:

   • Patient lies on a treatment table.

   • Pneumatic cuffs are placed on the legs and buttocks.

   • Electrocardiogram (ECG) is used to synchronize cuff inflation and deflation with the cardiac cycle.

2. Session Duration:

   • Each session lasts about 1 hour.

   • Typically, a full course consists of 35 sessions over 7 weeks.

3. Monitoring:

   • Heart rate, blood pressure, and patient comfort are continuously monitored.

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Benefits

1. Symptom Relief:

   • Reduces frequency and severity of angina.

   • Improves exercise tolerance.

2. Hemodynamic Improvements:

   • Enhances coronary perfusion.

   • Promotes collateral circulation.

3. Non-Invasive:

   • Avoids the risks of invasive procedures.

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Side Effects

1. Minor discomfort from cuff pressure.

2. Skin irritation or bruising in the cuffed areas.

3. Transient hypotension or fatigue in some patients.

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