EECP

EECP(ECP) or Enhanced External Counter Pulsation is a modern machine designed in USA and approved by USDFA for treatment of heart disease arteries. It increases blood flow to the diseased arteries by 200% and opens up collaterals. Thus it relieves chest pain and difficulty in breathing. The patient can walk longer, breathe easier and have a much better quality of life. The five year survival rate is the same for surgery, stents and EECP(ECP).

Who can benefit from EECP(ECP) ?

• Those who have been advised bypass surgery and choose not to have it.

• Those who cannot afford the cost of bypass surgery.

• Those who have other diseases which make them unfit for surgery eg. coexisting Diabetes Mellitus, Bronchial Asthma, Kidney failure, Thyroid disorders, old age i.e. more than 80 yrs.
• Those who have already had bypass surgery done a few years earlier and don't want to suffer the experience again.
• Those patients who cannot afford the exorbitant cost of angioplasty (upto Rs 3.75 lacs with two cipher stents and reopro).
• Those patients who have chest pain or breathlessness of cardiac origin and do not wish to undergo any further investigation can go for EECP(ECP) directly.
• Patients whose stents have got blocked again.  

How does EECP(ECP) work?

Actually it is quite simple. The patient lies comfortably on a couch in an A/c room. The legs, thighs and buttocks are enclosed in rubber bladders like those in a BP cuff. Three electrodes are placed on the chest wall to monitor the heart rhythm. One sensor is placed on the index finger or earlobe to monitor the pulse wave. The machine is then started and it sends pressure waves to the air bladders synchronized with the heart beats in such a way that when the heart contracts, a negative pressure wave is sent through the legs so the blood meets with very little resistance. When the heart relaxes (during diastole) positive pressure waves send the blood back to the heart in a more effective manner. So the coronary perfusion is increased by 200%.This causes the collapsed collaterals to reopen and provide blood to areas starved of oxygen. In brief EECP(ECP) results in

• Increased diastolic perfusion pressure.
• Increased coronary perfusion.
• Increased coronary collateral flow to ischemic regions of myocardium.
• Increased ventricular load.
• Increased venous return.

How does the patient know it benefits him ?

• Patient starts feeling better in 3-5 days.His chest pain become less & his difficulty in breathing becomes better.
• He can walk longer distances without onset of chest pain. His daily need of sub lingual nitrite tablets (sorbitrate or GTN) reduces dramatically.
• TMT or exercise test is done before and after EECP(ECP). The ST segment depression seen before is markedly decreased eg. a 2-3mm ST depression can easily become 0.5-1mm after 35 days of EECP(ECP). The patient who could exercise say 4mins on the treadmill earlier can now exercise 10 mins without onset of chest pain or breathlessness.
• Echocardiography is done before and after EECP(ECP). Ejection fraction or the efficiency of the heart improves from say 25% to 40% after 35 days of treatment.
• There may be visible improvement in the ECG in the form of heart rate, ST segment depression & ectopics.
• Stress thallium done before and after shows improved perfusion i.e. blood flow can be seen in those areas of the heart which were earlier starved of blood. Thus we see a marked improvement in almost all parameters of cardiac function measured before and after EECP(ECP).

So the good effects of EECP(ECP) can not only be felt by the patient but can also be demonstrated to his relatives and his treating Physician.

Cost of treatment (comparison)

EECP(ECP) is available in the most advanced Medical Cardiac centers like
     The Cleveland Clinic
     John Hopkins Medical center.
     Texas Heart Institute
     The Mayo Clinic
     JKF Medical Center Atlantis
     BIMC New York city
     University of California San Diego

• In London the cost is $12,000 and the waiting list is huge ref. The Sunday Express dtd. March 7th 2004
• In Randhawa Hospital Amritsar, the total package cost is $ 2,500 only This includes 35 1hr EECP(ECP) sittings + complete blood tests including lipid profile, TMT test, and ECHO done before and after EECP(ECP). Arrangement for accommodation can be made within the hospital @ US$ 30/day AC, @ US$ 50/Day in 3 Star Hotel within 800 Meters of the Hospital or @ US$ 70/Day in 4 Star Hotel within 2km

Advanced Medical Treatment

Most cardiothoracic institutes use very small doses of Beta blockers, ACE inhibitors, Statins & Fibrates after Angioplasty (stenting) or bypass surgery. This results in

re-blockage of arteries after 2-4years.
The advantage of EECP(ECP) combined with AMT is that we can use suitable and full doses of protective drugs because the patient is under such close observation for 35 days so there are no chances of unobserved side effects. We exceed the targets set by AHA (American Heart Association), ATP III panel for cholesterol management and by ADA (American Diabetes Association).
We aim to reduce Cholesterol to < 150, Triglycerides to < 100, LDL to < 70, VLDL to < 25 and increase HDL to > 45.  It has now been proved that if these targets can be achieved then disease progression is not only completely stopped but even the existing blockages are removed. So after EECP(ECP) and AMT there is a very good chance you may never have heart disease again

Advantages of AMT

• Cholesterol < 150
• Triglycerides < 100
• LDL < 70
• VLDL < 25
• HDL > 45
• Negligible chance of unobserved side effects.
• Very few chance of re-blockage after EECP(ECP) and AMT.
• 95% success rate in relieving angina.
• Appropriate weight loss achieved.