This relatively new therapy External Counterpulsation (ECP), an innovative, US FDA certified non invasive treatment option is now available in Bangladesh. ECP provides an opportunity to treat and improve the quality of life for “no option” angina and Congestive Heart Failure (CHF) patients who are refractory to medications and those who are non-surgical candidates. Clinical studies have demonstrated that ECP therapy benefits more then 80% of patients treated with significant improvement in relief of the symptoms, increased functional capacity, and reduced dependence on medication.

Clinical studies at top-rated hospitals including Yale Columbia Presbyterian in New York City, University of California San Francisco, University of Pittsburgh, and Harvard Deaconess Hospital, have demonstrated both the safety and efficacy of ECP, in addition, the Nicore^TM ECP therapy system has been reviewed and approved by Food and Drug Administration USA. To date ECP has been performed on thousands of patients across the world with results indicating outcomes in excess of five years. These outcomes were fewer episodes of angina, elimination or subsiding of anti-anginal medications, and a return to more active lifestyle.

How does ECP Work?

A computer interprets the patients ECG and provides timing signals that control the sequential inflation and deflation of pressure cuffs wrapped around the patients calves thighs and buttocks. Each inflation cycle is timed to start and end during the resting phase of the patients heartbeat (diastole)

As diastole begins, the cuffs inflate rapidly and sequentially from the calves to the buttocks, firmly compressing the patients vasculature. This has two immediate effects: One a strong retrograde “ counterpulsation” occurs in the arterial system, forcing fresh oxygenated blood back towards  the heart and coronary arteries, and two an increased volume of venous blood is returned to the heard under increased pressure. The combined effect of these two events is to increase the oxygen supply and perfusion pressure in the myocardium (heard muscle) and a increase “per-load” so the heart has a greater volume of blood to pump during the next systolic event. Next as the patients hears nears the end of diastole and prepares for systole (ventricular contraction), the computer instructs the deflation valves to open so a vacuum can deflate the cuffs instantly.

This action also provides therapeutic advantages by reducing the heart’s after-load. Since the vascular beds in the lower extremities are essentially empty, the resistance to blood flow is markedly reduced , thereby decreasing the amount of work that the heart must do to pump blood to these areas (reducing oxygen demand within the myocardium).

As a result of these diastole augmentation activities, the patients peak diastolic pressure is significantly increased, benefiting circulating in the heart muscle and in other organs as well. At the same time, the patients systolic pressure is reduced to the general benefit of the vascular system. Clinical studies suggest that the increase in myocardial perfusion pressure stimulates the use of collateral vessels that are already present but unused , thereby allowing oxygenated blood to bypass ischemic areas in the heart.

Who does it work best for?

For many angina and congestive Heart Failure (CHF) sufferers, ECP therapy may be a preferred alternative to bypass surgery, angioplasty, stenting or medication. ECP may be indicated for patients who have already had or not good candidates for surgical intervention. It is often an ideal choice for stable angina patients with single or multiple vessel coronary artery disease. In some cases, patients may be able to improve coronary circulation and perfusion pressure before a scheduled bypass surgery.

The treatment is also useful for patients who do not tolerate or who prefer not to rely medication.

ECP may be inadvisable for patients with certain conditions including recent surgical intervention, uncontrolled arrhythmia, pacemaker, severe pulmonary disease, severe hypertension, aneurysms, pregnancy or the presence of a burn, open wound of fracture on any limb subject to ECP treatment.

What are the benefits?

Most patients report that after the full course of treatment the angina symptoms are reduced or eliminated and they have a great tolerance for exercise. There social actives are no longer restricted and their dependence on anti-angina medications is lessened or eliminated.

In addition to the subjective benefits of a more active lifestyle, ECP has been shown to provide long-term relief from angina symptoms. Although it is difficult to foresee how long the effects of ECP will last in an individual patient, studies show that the majority of patients sustain their ECP benefits for as long as 5-6 years.

ECP therapy provides benefits that a physician can use to determine the effectiveness of treatment. Benefits are easily measured by response to exercise stress testing and radionuclide imaging. (For example, Thallium 201 imaging can clearly depict the increase in perfusion to previously ischemic areas of the heart.)

What is the course of treatment?

A prescription for ECP treatment normally specifies a total of 35 hours of therapy, administered for one hour per day , 6 days a week. Although most patients begin to experience relief from their angina symptoms after 12 -13 hours of treatment, some patients may require additional week of treatment before the angina symptoms are resolved.

Because ECP is totally non-invasive and non pharmacological, the risk associated with the treatment are extremely low. The most commonly reported side effects are skin irritation or temporary muscle aches, resulting from the inflating and deflating and deflating action of the pressure cuffs.