What is ECP?

What is Enhanced External Counterpulsation? 

Enhanced External Counterpulsation (ECP or EECP) is a revolutionary, non-invasive way to prevent the need for heart surgery. To fully understand ECP and it’s wide range of benefits, we must first step back and understand the physiological mechanisms of the circulatory system. We also need to explore current conventional treatments to cardiac and circulatory pathology that can be avoided with the use of ECP.

What Is Cardiovascular Disease?

For decades we’ve heard that cardiovascular disease (CVD) is the number 1 killer in the world. It results in around 650,000 deaths per year in the USA alone, which is about 1 in every 4 deaths. It is highly likely that someone close to us has passed or is currently dealing with this condition. 

The most common type of CVD is called coronary artery disease (CAD). CAD starts as a buildup of cholesterol in the coronary arteries (the main blood vessels that supply our heart muscle) called atherosclerosis. Given the standard American diet, this change takes place very early in most of our lives, often as “fatty streaks” in childhood. As the poor diet and lifestyle decisions continue, the bad cholesterol, known as LDL, builds within the walls of our arteries into full blown atherosclerosis. This stockpile of cholesterol causes a decrease in the diameter of the coronary vessels leading to a lack of blood supply to the heart. The reduction of blood supply is known as myocardial ischemia and can lead to angina or myocardial infarction aka heart attack.

Angina is a common type of chest pain

What Is Angina?

Angina is a squeezing, pressure-like pain often provoked by an increase in cardiac workload via physical exertion and usually subsides a few minutes after exercise has stopped. However, if the cardiovascular disease is developed enough, physical activity may not be required to induce this painful sensation or it may take longer for the pain to stop. Think of angina as a warning sign that the blood vessels in your heart are suffering from blockage, which can eventually lead to a heart attack. 

What Exactly Is a Heart Attack? 

Cardiovascular disease can get so severe that the diameter of the coronary blood vessel affected becomes completely occluded, or blocked. When this happens, there is little to no blood supplying the heart muscle in that designated area and the tissue begins to die. This event is termed myocardial infarction (MI), or heart attack. It is obviously a very emergent situation and needs to be treated immediately before too much heart muscle expires. According to the Centers for Disease Control (CDC) an MI occurs in America every 40 seconds.

Coronary angioplasty with stent

What Are Stents?
What Is Angioplasty?
What is Bypass Surgery?

When narrowed coronary arteries threaten the heart’s blood supply, Cardiologists usually recommend angioplasty (balloon implant) plus stenting (mesh insert) or a coronary artery bypass graft (CABG).

Angioplasty plus stenting is a less invasive procedure compared to the latter as a balloon with mesh stent is placed within a wire and is navigated through the patient’s groin or arm up to the affected coronary blood vessel. It is then expanded and released to create a larger pathway for blood to freely pass.

CABG is considered open heart surgery, in which an artery or vein from elsewhere in the body (usually the leg) is stitched into the heart to reroute blood “bypassing” the blockage within the coronary artery. 

Although the issue is being addressed and you likely attain immediate relief, this is only a bandaid for a deeper problem. CABG usually buys the patient about 10-15 years before they too become clogged, while stents tend to last a bit longer.

What Are Complications of Heart Surgery?

Surgery always comes with many risks, especially when dealing with such a vital organ in the body. While rare, in-surgery risks include heart attack, direct coronary artery damage via surgeon manipulation, kidney damage (by use of contrast dye during imaging), stroke (cholesterol plaque may become dislodged and travel to the brain) and abnormal heart rhythms. 

Post-operative complications include bleeding (usually from a residual heparin effect or incomplete surgical hemostasis), thrombosis (due to increased platelet activity), pulmonary dysfunction (pleural effusion, pneumonia, atelectasis, acute lung injury and acute respiratory distress syndrome (ARDS)), renal dysfunction (acute kidney injury) and neurological dysfunction (stroke, seizure and memory loss).

What is ECP?

ECP is a seemingly bizarre therapy that works by lying the patient down and placing cuffs (essentially blood pressure cuffs) that squeeze the lower limbs in a timed manner that is synchronous to the heart beat. The cuffs squeeze while the heart is at rest to increase the amount of blood in the heart, however they release when the heart pumps so that the heart doesn’t have to pump against pressure. The heart’s blood vessels then release a chemical called VEGF (vascular endothelial growth factor) or FGF (fibroblast growth factor) which are responsible for angiogenesis, or creation of new blood vessels on the surface of the heart. It is the formation of these new blood vessels which combats heart attacks and angina by allowing your heart to maintain adequate blood perfusion to the heart muscle at all times. In a way, the patient is creating their own natural bypass mechanism. The overall mechanism is similar to that of exercise, but without having to move.

ECP improves heart strength without the need for exercise

How Often Will I Need It?

ECP is performed 5 days per week for 7 weeks; a total of 35 sessions. This regimen has been shown to cause great benefit. In multiple clinical studies, they found that this plan has been very well tolerated, caused increases in exercise capacity, showed decreases in the incidence of angina, and also many of the patients in the studies were able to discontinue their nitroglycerin medication.

Conclusion

Ideally, we want to avoid coronary artery disease with healthy lifestyle habits, because all of these modalities can be disrupted by atherosclerosis. However, the medical industry has preached “better diet and more exercise” for ages without success. 

Despite its vast assistance in combating the most deadly disease known to us, ECP is not commonly used in practice. In America it’s only seen in specialized cardiovascular centers which use them for refractory angina or for patients who, in the opinion of the cardiologist, are not good candidates for heart surgery. If we are using this non-invasive technique for “more difficult to treat” angina then it must be a very effective technique and should be more well known.
Although only seen in limited areas around the country, Preventive Medicine in Georgia has two top of the line ECP tables that are available for patient use. See information regarding our tables HERE.

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Zach Zarzour, MD

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