"I feel better than I have in many years.  This treatment helped more than my bypass surgery ever did."  Randy, after completing ECP treatment.

What is ECP?

External Counterpulsation (ECP) is a procedure to treat symptoms of angina without stents.  Enhanced External Counterpulsation (EECP) is the same treatment, but refers to the brand name of one particular company.  Angina results from inadequate oxygen to the heart from blocked arteries, inadequate artery relaxation, or from inadequate transfer of oxygen in the heart cells.  Symptoms of angina include chest tightness, shortness of breath or fatigue that is provoked by emotional, physical or mental stress.  Angina may occur in patients with extensive cholesterol atherosclerotic heart disease, or in patient with normal appearing arteries (termed microvacular angina).  Fatigue is often the primary symptom, and some patients without chest pain still notice a great improvement in energy levels with treatment.

Initial evaluation includes a stress test or angiogram, and treatment with medications.  There are four classes of medications used for treating angina.  Many angina patients are able to be treated with angioplasty, stents, or bypass surgery.  Some patients may have been told their symptoms are not heart related because no blockage can be identified.  Other patients have heart disease that is not treatable by conventional methods, or they do not want to undergo invasive procedures.  All of these patients may benefit from ECP.

ECP is a non-invasive outpatient treatment alternative to procedures or medications. ECP is highly effective in relieving angina in most patients with little risk. Patients with atrial fibrillation and certain valve or lung disease may not qualify for treatment.  Approximately 80-90% of patients feel significantly better after completing a course of therapy.  Patients typically report less frequent or severe chest pain, less use of nitroglycerin, less shortness of breath, improved energy and quality of life. Patients qualify for treatment if symptoms occur with minimal activity or stress, or occur at rest (Class 3 or 4 angina).

How is the procedure done?

Patients who qualify for treatment are placed on our waiting list.  Erica, our technician, will call you with available time slots starting between 7:30 am and 4:00 pm.  Treatment sessions last about an hour, and are done 5 days/week for 7 weeks in a row.  It takes approximately 4 weeks to notice improvement in symptoms, although some patients report improvement within the first week.  It takes a strong commitment to keep your appointments, and if several sessions are missed, you may lose the priveledge of continued treatement.

Prior to starting treatment, you will need and EKG and Echocardiogram.  You will start on a low inflation pressure, and be given an instructional video to watch.  Patients lie on a special bed with three blood pressure cuffs for each leg.  These cuffs inflate in timing with the heart beat.  First blood is pumped back into the heart (coronary) arteries when it is relaxed.  Second, the cuffs deflate quickly to reduce the workload of the pumping heart.

Patients usually report they feel as if they have just exercised after a treatment.  Legs may be sore and tired for a few days after treatment. 

Are there any risks?

Fortunately, complications are rare and usually treatable.  Patients may develop ulcers or blisters on the legs from the pressure of the cuffs, especially in patients with very fragile skin, or who are on Coumadin, a blood thinner.  This is usually treatable with extra padding in these areas.  We have had patients develop low blood sugars during treatment due to the exercise that is done.  This is treatable with having a little juice before the procedure.  ECP may also worsen heartburn from the pressure on the lower abdomen.  We ask patients do not eat for 2-3 hours prior to the procedure.  Patients are monitored continually during the procedure.

How does the procedure work? 

Growth factors (VEGF, FGF) are increased during ECP therapy, and remain elevated after treatment stops.  This allows for growth of new blood vessels.  Animal models have shown a significant increase in the number of heart blood vessels after treatment.  Also, studies have shown the body will increase production of nitric oxide, which relaxes the heart arteries, and allows for better blood flow.  These levels stay elevated for months after ECP treatment has stopped.  In addition, the constricting factor endothelin is reduced with ECP treatment.  This treatment simulates exercise for the heart.  Exercise may possible result in similar benefits, but most patients undergoing treatment are unable to exercise enough to derive these benefits.

Does insurance cover the costs?

Currently, most insurance plans in Utah do cover the cost of treatment.  However, Medicaid and Molina cover only a portion of the cost.  Blue Cross/Blue Shield has decided to drop coverage altogether, and some IHC plans do not cover this therapy.  Our billing department can work with you to come up with an acceptable treatment plan if your insurance does not cover therapy.

Case Examples:

Typical Angina:

A 46 year old male with diabetes and high cholesterol underwent a five vessel bypass surgery.  Over the next several years he had multiple stents placed.  He was treated with maximal medical therapy, but continued to have frequent chest discomfort.  He was treated with ECP, which resolved his chest pain.  He exercised regularly and followed a vegetarian diet.  After a year his angina returned.  He had additional stents placed, but continued to have angina symptoms, requiring nitroglycerin tablets frequently.  He was desperate to have ECP treatment again, but had to wait until a treatment bed was available.  After an additional course of treatment, his angina and quality of life again greatly improved again.  He now wishes to complete a course of therapy once a year.