Keeping angina at bay CHITRA RAMASWAMY (Contributor) 21 April 2007

HEART PATIENTS who can barely walk a short distance without running out of breath, may get a new lease of life by using revolutionary pumps that enable them to return to everyday activities. EECP or Enhanced External Counter Pulsation is a completely noninvasive complementary therapy for cardiac patients who suffer mild to moderate heart failure and from angina which is one of the main symptoms of coronary artery disease. Angina is chest pain or discomfort which results from the heart muscles not getting sufficient supply of blood and therefore oxygen for the work it is doing.

EECP is a technique to increase the flow of oxygenated blood to the heart and reduce its workload, explains Dr. Daffodils G. Guevarra, Specialist Physical Medicine and Rehabilitation, Rochester Wellness Clinic, Dubai.

Though the concept of Counter Pulsation originated in the 1950s, it was only in the 1990s that the technique was simplified, made totally noninvasive and perfected with the use of computer technology. Hence it’s a therapy which has not caught on yet in several countries of the world and several specialists from the medical fraternity as not too aware of the options it has opened up in cardiac and other medical areas.

The heartbeat consists of two phases: the diastole or the fraction of time when the heart relaxes between contractions, and the systole which is the contraction phase. During diastole, the heart gets its maximum supply of oxygen and this is where EECP comes into play. EECP is a strategy for increasing the blood flow back to the heart during the diastolic phase. EECP helps strike a balance between the amount of oxygen the heart needs and the amount it gets. When this balance is achieved, anginal pain is reduced, both in frequency and intensity. There is decreased need for medication, the level of exercise is improved, feeling of fatigue is very much reduced and the patients enjoy a general sense of well being with quality of life being improved.

Why EECP relieves anginal pain, pressure or discomfort, is conjectural. The most probable explanation for the benefits from EECP relate to the technique’s ability to trigger a natural process in the body, to promote collateral circulation. EECP increases the amount of oxygenated blood that reaches the heart by dilating the tiny, narrow collateral blood vessels which surround the main blood vessels. EECP effectively fools the collateral mechanism by creating additional pressure when the heart relaxes, prompting the collaterals to remain dilated. These collaterals, during the course of 35 sessions may develop into permanent alternative pathways for significant blood to reach the heart. Thus patients’ cardiac symptoms are reduced or even eliminated.

EECP is indicated for cardiac patients who have chronic, stable angina, those who do not find relief with medication and those patients who cannot withstand more invasive treatments like angioplasty or bypass surgery.

However, not all cardiac patients make suitable candidates for EECP. Individuals who do not qualify for EECP include patients with unstable or unpredictable angina, those with uncontrolled hypertension, patients who have arrhythmia or irregular heart beat, patients with active vascular infection and vascular problems, patients with severe heart failure, people who have a tendency to bleed excessively, patients with serious valvular heart disease and pregnant women. EECP is also not advised for people who are on anti coagulants or blood thinners, those with pacemakers and implantable cardioverter defibrillators.

What does the EECP technique involve? The EECP machine uses a series of inflatable pads attached to a patient's legs to force blood back to the heart. The blood is squeezed in an electronically controlled sequence to improve circulation and provide a better supply of oxygen-rich blood to the heart. Inflatable pads or cuffs similar to the ones used to measure blood pressure are strapped on to the patient who is comfortably made to lie on a padded table. Three sets of electronically controlled inflation and deflation valves are connected to the three cuffs that get firmly wrapped around the patient’s upper and lower thighs and calves. Signals that run from an electrocardiogram machine to a microprocessor, control the valves. During diastole, the three cuffs rapidly inflate in a sequential order from the calves to the upper thigh. This action forces blood back to the heart. Just before the next heartbeat, the cuffs deflate with appropriate rapidity. This inflation-deflation cycle repeats itself 60-80 times every minute during the one hour session of therapy. The procedure involves no pain except that some patients may experience discomfort in the form of a sensation like a strong hug travelling from the calf to the thighs.

Prior to the procedure, a patient’s medical history is taken and physical examination done. This includes vital signs being recorded: weight, pulse rate, blood pressure and breathing rate are measured. Also, the legs are examined for areas of redness, infections and signs of potential vascular problems including varicose veins. Patients are usually advised to wear tight-fitting clothes to prevent possible chafing which is the only adverse effect one may experience with EECP.

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