Enhanced external counterpulsation (EECP) is a treatment for chronic, stable chest pain known as
. Angina happens when there is not enough blood and oxygen being pumped to the heart to support the work it is doing.
EECP may also be used to treat certain people with
Cuffs, similar to blood pressure cuffs, are placed on the legs. These cuffs inflate and deflate with air to the rhythm of the heart. This helps to push blood back toward the heart, increasing blood flow. Since circulation is improved, the heart does not have to work so hard.
The Cardiovascular System
EECP pushes blood back toward the heart to reduce the heart's workload.
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You may have EECP to treat angina if: Your medications are not working well enoughYou are not a good candidate for surgeryYour doctor wants you to try a nonmedical alternative before considering surgeryYou have had surgery but are still having chest pain
The benefits of EECP may include: Decrease in symptoms of anginaDecreased need for angina medicationsAbility to do activities, such as exercise, without anginaImproved heart function if a lack of oxygenated blood flow is a problemImproved quality of life
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like: ChafingBruising or blistersBleeding if your blood is too thinLeg or waist painWorsening of heart failure in people who have certain heart rhythm abnormalities
You should not have EECP if you are pregnant or have any of these conditions: Severe heart failure
Certain heart valve problems, such as significant
Problems with heart rhythm, called
arrhythmiasHigh blood pressure
you cannot control with medications
Blockages in the veins or arteries of your legsRecent heart catheterization
chronic obstructive pulmonary disease
Before you begin EECP, your doctor may: Discuss your medical historyDiscuss any medications you are taking—your doctor may not recommend EECP if you take blood thinnersAnswer any questions you have about the procedure
You may want to wear tight-fitting, seamless pants. This can help prevent chafing from the cuffs.
You will not be given any anesthesia. EECP is not painful.
You will lie on a padded table. Electrodes will be placed on your chest to monitor your heart rhythm. Your blood pressure will also be monitored.
Cuffs will be placed on your calves and upper and lower thighs. The cuffs attach to air hoses that will inflate and deflate them in rhythm with your heart. You will feel strong pressure from the cuffs, beginning at your calves and moving to your upper thighs. The cuffs will inflate 60-80 times each minute during the treatment.
You will be treated for a total of 35 hours. Treatments are usually given
each day over 7 weeks.
EECP is not painful. You may feel uncomfortable when the cuffs tighten on your legs.
After your treatment, the electrodes and cuffs will be removed. You can go home as soon as you are done with treatment. You may feel slightly tired after the treatment. This feeling will get better over time.
When you return home, do the following to help manage your angina:
If you smoke,
talk with your doctor about how you can
.Manage your weight.
.Drink plenty of fluids throughout the day.Exercise regularly
and stay as active as possible.Go to any recommended appointments.Follow your doctor's instructions.
After arriving home, call your doctor or call for medical help right away if there are signs that your angina is getting worse: Severe chest pain that may feel tight or heavyShortness of breathNumbness or tingling in shoulder, arm, or wristNauseaSymptoms not relieved with medication
If you think you have an emergency, call for emergency medical services right away.
Amin F, Al Hajeri A, Civelek B, et al. Enhanced external counterpulsation for chronic angina pectoris.
Cochrane Database of Systematic Reviews. 2010;2:CD007219.
Enhanced external counterpulsation. Cleveland Clinic website. Available at:
http://my.clevelandclinic.org/heart/disorders/cad/eecp.aspx. Updated May 2015. Accessed June 9, 2016.
What is angina? National Heart Lung and Blood Institute website. Available at:
http://www.nhlbi.nih.gov/health/health-topics/topics/angina. Updated June 1, 2011. Accessed June 9, 2016.
What is angina? American Heart and Stroke Association website. Available at:
http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300287.pdf. Published 2015. Accessed June 9, 2016.
Manchanda A, Soran O. Enhanced external counterpulsation and future directions: step beyond medical management for patients with angina and heart failure.
J Am Coll Cardiol. 2007;50(16):1523-1531.
Last reviewed June 2016 by Michael J. Fucci, DO, FACC
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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