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Enhanced External Counterpulsation Treatment (EECP)
Enhanced External Counterpulsation, or EECP, is a non-invasive outpatient treatment that has been proven (no longer a research trial) to decrease or even eliminate chest pain (angina) in patients who are not ideal candidates for coronary artery bypass or coronary angioplasty. The theory behind the EECP system is that the counterpulsation pumps oxygenated blood to the heart when the heart is at rest, and helps open new pathways for blood to travel around the narrowed or blocked arteries that are causing your angina. The ultimate goal of the EECP treatment is to decrease or eliminate your angina, by increasing the amount of blood being supplied to your heart.

EECP is FDA approved medical therapy and is covered by many health insurance companies including Medicare and Medicaid. EECP sessions are typically one hour per day, Monday through Friday, for seven weeks. For patients coming from a long distance, it is possible to have two treatments per day for three and a half weeks in order to decrease the amount of time away from home. However, studies have not confirmed that this is as effective as once per day for seven weeks.

Unfortunately, not all patients are appropriate candidates for EECP. There are two prescreening test required prior to starting EECP therapy which can be done at your local health care facility or at the Minneapolis Heart Institute. They include an adenosine cardiac MRI scan or an echocardiogram to assess the function of your heart and the valves, and an abdominal aortic ultrasound to rule out an abdominal aneurysm. Currently this treatment is not available for some patients with severe congestive heart failure, uncontrolled hypertension, tendencies toward excessive bleeding, some patients with atrial fibrillation, severe aortic valve disease, history of blood clots in the legs, or pregnant women. Patients with peripheral vascular disease may not get the results hoped for with EECP.

EECP may, however, prove to be an option for some patients who are not candidates for cardiac interventions, or for patients who have undergone treatments but continue to suffer with angina.  
Before the Procedure
You will be asked to continue to take all prescribed medications, but do not eat or drink anything else within 90 minutes of your EECP treatment. Remember to wear form-fitting underwear (not boxers), and short socks. Diabetics need to wear pantyhose to protect their skin from the friction of the cuffs. Plan to arrive a little early for your appointment so that you can change into a loose-fitting, comfortable top, and stretch pants (provided by MHI).

Patients with pacemakers will need to have their pacemakers checked by the pacemaker clinic prior to starting treatment. Depending on the model and settings of your pacemaker, the pacemaker check may occur only once at your first treatment session or daily prior to each EECP session.

When you get to the Abbott Northwestern Hospital campus, please check in at the Minneapolis Heart Institute Clinic desk on the second floor of the Minneapolis Heart Hospital building. (Choose from the following links to view maps and directions or a campus guide .) The EECP room is equipped with a TV/VCR and a CD player. Feel free to bring your own CD or cassette to listen to, or a videotape to watch during your treatment. The EECP room can accommodate one family member or significant other during your therapy session.
During the Procedure
After taking your blood pressure and documenting your weight, a therapist will connect electrodes to your chest to record an EKG throughout your treatment. Your therapist will then apply three sets of air cuffs, similar to those used to obtain blood pressure readings, on your calves, thighs and hips. (See image 1 below) You will lie on a padded table throughout your treatment while these cuffs inflate and deflate in synchrony with your heartbeat. When your heart is at rest the cuffs will inflate to push blood back to the heart, which provides your heart muscle with essential oxygen. When your heart beats, the cuffs deflate, which decreases the work-load on the heart. In other words, in this counterpulsation treatment, the cuffs counter the pulse of your heart. (See image 2 below)
After the Procedure

Your EECP treatment session will last one hour. After your treatment you may leave without restrictions. You may feel a little more fatigued than usual for the first week or two of treatment. It is important to inspect your skin for any signs of redness or irritation and to report that or any change in your condition to the EECP therapist.



Image 1:  Graphic reproduced with permission from Vasomedical, Inc.



Image 2:  Graphic reproduced with permission from Vasomedical, Inc.

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