Enhanced External Counter Pulsation for Angina, Heart Disease, High Blood Pressure

External counter pulsation is a non invasive, non surgical treatment for patients suffering from Coronary artery disease (CAD) in the form of Chest pain (ANGINA), breathlessness on exertion (HEART FAILURE).
Clinical studies have shown that upto 85% of CAD patients do not need Bypass surgery of stents and can be treated with ECP+AMT.
These patients have relief from chest pain, can breathe easier, walk longer, return to their jobs, and overall have a much better quality of life.
The beneficial effects of ECP last for 3-5 years or more after which it can be repeated as ofter as if at all – necessary.

Nearly everyone with coronary artery disease can benefit from EECP(ECP). EECP(ECP) is particularly well-suited to people who:

Have already had angioplasty, stents or bypass surgery, and the heart disease symptoms have returned or persisted.
Are not candidates for surgery due to other serious medical conditions
Do not want to undergo surgery or angioplasty.
Rely heavily on medicines, or have to curtail their activities to avoid angina and other heart disease symptoms.

How long does ECP take?

The standard course of treatment we offer is 35 one hour sessions over 25 days. In the first 10 days we give two sessions-one in the morning and one in the evening. The remaining 15 days we give single session per day. (a total of 35 one-hour sessions). Some patients prefer to have two treatments in one day in order to complete the program in 18 days. Some patients (failed Bypass surgery; blocked stents) may need to extend the program beyond 35 treatments, depending on their particular medical situation and goals.

How long do the benefits of ECP last?

Long term benefits are seen in data from international ECP patient registry (IEPR) at the Univ of Pittsburg USA. The benefits of EECP last for three to seven years after treatment (including less angina, less nitroglycerin usage, greater walking distance etc. and improved blood flow patterns documented on stress thallium and Treadmill testing).

Visible changes in ECG, ECHO, Lipid profile are seen after ECP+AMT.
Stress Thallium scan shows increased blood flow in those areas of the heart which were starved of blood earlier due to obstructions.
Usual angiograms show only the large epicardial arteries. A delayed angiogram done before and after EECP shows a marked increase in the number and size of reticular collaterals after ECP.

Arrhythmias that interfere with machine triggering
Bleeding diathesis
Active thrombophlebitis
Sever lower extremity vaso-occlusive disease
Presence of a documented aortic aneurysm requiring surgical repair
Pregnancy
Aortic regurgitation more than Grade II

How does ECP compare to angioplasty or bypass surgery?

The five-year outcomes for ECP patients are virtually the same as for angioplasty and bypass surgery pagients. Which means that today if a heart patient chooses anyone of these three, for the next five years his chance of a heart attack, angina, Heart failure or death are exactly the same. The side effects of Bypass surgery are far too many (including death). Stents have a tendency to get reblocked very soon especially in diabetics. EECP+AMT have no side effects and give the same results but at a fraction of the cost.

Is ECP USFDA-approved? What kind of research has been done on it?

ECP was approved by the SUFDA in 1995 as a treatment for coronary artery disease and angina. In 2002, the FDA approved ECEP as a treatment for congestive heart failure. It has undergone rigorous clinical trials at leading universities around the country and ECP has been the subject of more than 100 scientific studies published in leading medical journals throughout the world.

Where else is ECP/EECP available?

ECP or EECP is available in most of the leading hospitals in the world like, Mayo clinic USA; Texas Heart institute, Houston, Chromwell hospital London; Cleaveland clinic; Stony Brooks New York. However the cost in these places in exorbitant about US $ 9,000 for ECP alone. Cost of rrom rent, docots fees, nursing charges, medicines, blood tests is all EXTRA. Also AMT or OMT – optimized medical treatment is NOT a part of the package at these places. So the overall cost works out to about US $ 20,000 at these centers.

I have congestive heart failure (CHF). Is that a problem with ECP?

No, in fact, in July 2002 the FDA approved ECP as a treatment for congestive heart failure (CHF). After completing a course of ECP treatment, patients with CHF typically have less swelling in their legs, less shortness of breath, less fatigue, and often require less diuretic medication. AMT has drug components in it which increase Ejection, Fraction, decrease symptoms, prevent frequent hospitalizations and prolong life.

I have a pacemaker. Can I still do ECP?

Yes EECP+AMT do not interfere with the functioning of Pace makers-single chamber or dual chamber, Implanted cardiac Defbrillator; Cardiac resynchroning devices or Combo devices. In fact after EECP+AMT, heart failure improves so much that the need for these devices decreases i.e. less ischemia means less arrhythmias, less asynchrony, longer life.

Can very old, very serious and bed ridden take this course?

The most remarkable aspect of EECP+AMT is that when no other treatment is available to the patient (when he is unfit for Bypass surgery and stents very old; serious co existing diseases like diabetes, asthama, obesity, hypothyroidism, kidney failure, cancer etc.) even in these patients it is very effective and life saving. We have treated patients who have been refused treatment by leading hospitals in the world. These include multiple Bypass surgery failures, multiple stents reblocked, Ejection Fraction as low as 15%.

Randhawa Hospital introduces for the first time in India EECP(ECP). EECP(ECP) is available for treating angina in all leading hospitals of the world, including Cleveland, Mayo, Stony Brooks and Escort Heart Hospital in Delhi.

Developed by Vasomedical, Inc., EECP(ECP) has been tested in multicentre, controlled, clinical studies, with positive medical results and demonstrated quality of life improvement. Enhancing your life's rhythm is the heart of EECP(ECP). And with Medicare's coverage, there's one more good reason to ask your doctor if EECP(ECP) is the treatment for you.

EECP(ECP): A non-invasive, outpatient treatment

Unlike procedures such as bypass surgery, balloon angioplasty, and stents, EECP(ECP) is entirely non-invasive (involves no surgery, drugs or needles), carries no risk, is comfortable, and is administered in an outpatient setting. In fact, EECP(ECP) can feel like a deep muscle massage to the legs and the patient is completely relaxed during the process.
EECP(ECP) is administered as an out-patient procedure, making it very convenient for the patient and the family. The EECP(ECP) pumping console then rapidly inflates and deflates the leg cuffs in time with the heartbeat.

EECP(ECP) treatment may be the only way to obtain relieve from crippling angina.

What is Angina?

Angina pectoris literally means, 'strangling in the chest'. It is the most common symptoms of coronary artery disease. The majority of patients with Angina complain of chest discomfort provoked by mental, physical or emotional stress. The discomfort can vary widely among patients who report shortness of breath, fatigue, indigestion, faintness, pain in the chest, arm, neck, or jaw and other symptoms.

What causes Angina?

Angina signals that a part of the heart muscle is not receiving an adequate supply of blood and oxygen. The heart requires a particularly rich blood supply because of its heavy workload, and receives this nourishing blood supply through the coronary arteries. When narrowed or blocked arteries restrict blood flow, oxygen supply to portions of the heart may at times be insufficient. Increase in oxygen demand can occur during exercise, fever, rise in emotion, periods of hypoglycemia, or after meals, triggering the onset of Angina.

How does Angina affect people?

Angina often occurs when exertion outstrips the ability of narrowed or blocked coronary arteries to supply blood to the heart muscle. Angina restricts activity for many patients. They are able to walk, but not uphill nor while carrying packages. For some, Angina is disabling as it interferes with their ability to work or engage in almost any activity.

What is ECP treatment?

Is there any comparison of ECP treatment with other interventional treatments like Bypass and angioplasty?

Even though the patients treated with ECP are sicker group when compare to the patient undergone interventional procedures the results are comparable in spite of the disparity of risk profile in the two groups.

The 5-year survivals of ECP patients are 88% similar to the results seen in contemporary Bypass and angioplasty trail. (April 2000 clinical cardiology)

Study comparing two ECP registries at Pittsburgh and Angioplasty registry at National heart lung and Blood institute (American Journal of Cardiology 2002 may 15th issue) shows the 1-year survival and adverse events results are comparable. But 17.2% of angioplasty patients went for repeat angioplasty procedure while only 6.3 % of ECP patients underwent repeats ECP. Also twice the no of patients in Angioplasty group reported to use Short time nitroglycerin when compare to ECP group.

How popular is this treatment?

In USA 1996 ECP got FDA cleared and 1999 Medicare Insurance coverage. Leading Cardiology centers like Mayo clinic and Cleveland clinic has ECP center. In India after the company launched ECP a year ago now there are six centers including Escorts Heart and research institute.
By 2006 there are approximately 2000 ECP systems installed worldwide.

What is EECP(ECP) how is it different from ECP?

EECP(ECP) stands for Enhanced External Counter Pulsation it is the registered trademark of Vasomedical inc. USA., otherwise the treatment as such is called as ECP. Hence EECP(ECP) treatment and ECP treatment have no difference.

Those who are afraid of Surgery.
Those very old patients more than 75 years of age and unfit for surgery.
Patients with diabetes, blood pressure, kidney disease, overweight, asthma, hypothyroid or other serious disease making them high risk for surgery.
Patients with failed Bypass surgery (recurrence of chest pain after bypass)
Those patients whose stents have got blocked again.
Those whose chest pain cannot be controlled with multiple drugs.
Those who have exhausted all options known to man eg two Bypass surgeries, upto ten stents, advanced heart failure, EF less than 30%.

Chest pain markedly decreases in intensity and frequency from the 3rd to 5th day.
Breathing becomes easier and he can walk longer by the 10th day.
Dramatic decrease in the number of Nitrite sprays or sublingual tablets.
A great sense of wellbeing and improvement in quality of life.