Coronary Artery Disease (CAD) is a narrowing or blockage of the vessels (coronary arteries) that provide oxygen and nutrients to the heart. It is caused by accumulation of fatty materials (atherosclerosis) on the inner linings (endothelium) of coronary arteries.
In India, the incidence of CAD (Heart attack) patients is steadily increasing due to moderanisation of life style. Approximately 16% of total wolrd-wide deaths due to heart attack occur in India
The heart attack patients need emergency medical care and investigations, and after confirming the diagnosis, physicians advise medical treatment, angioplasty-stent and / or bypass surgery, which have their own limitations. During & after these surgical interventions, many patients encounter various complications including blockages of stents & bypass grafts within 5-10 years. Furthermore, these invasive treatments target only the obstructive lesions, but the disease & its cause are still present after treatment because Coronary Artery Disease is a progressive disease.
Enhanced External Counter Pulsation (EECP) therapy with its different mode of action like progressive angiogenesis leading to development of collaterals, improvement in endothelial function, anti-inflammatory effect and release of vasodilator peptides, provides a new treatment modality in the management of CAD and complements the invasive revascularization. It is a non-invasive, outpatient therapy consisting of electrocardiography (ECG) – gated sequential leg→thigh→buttock compressions which produces hemodynamic effects similar to those of an intra-aortic balloon pump (IABP).
EECP has been approved by US-FDA (USA), NHS (UK), CE-mark certification (Europe), American Heart Association (AHA) and American Collage of Cardiology Foundation (ACCF) for the treatment of Ischemic Heart Disease and Heart Failure.
EECP therapy consists of a treatment bed attached to an air compressor unit which is attached to a computerized control console. Three sets of cuffs wrapped around the lower legs, thighs & buttocks of the patient which inflate rapidly and sequentially at an interval of 0.4 seconds starting from the calves→thighs→buttocks during the relaxation phase of heart beat (Diastole). This creats a strong retrograde counterpulse (Pressure as high as 220-300 mm Hg) in the arterial system, forcing freshly oxygenated blood to the coronary arteries and in the venous system, increasing the venous blood return. Just before the next heart-beat (Systole), all three cuffs deflate simultaneously, reducing the heart’s after-workload by significantly lowered resistance to blood ejected by the heart in the relatively empty vascular beds in the lower extremities.
EECP therapy course generally consists of 35 sittings administered 1 hour a day over 5-7 weeks.
EECP is a non-invasive & outpatient therapy, beneficial in relieving Angina pain in almost 80% patients not responding to maximal medical treatment and is advised in :-
- Patients who have previous invasive revascularization treatment like Angioplasty-Stent & / or Bypass surgery being failed due to stenosis of stents or blockage in bypass grafts.
- Patients who are not fit for invasive / surgical procedures because of unsuitable coronary anatomical effects like diffuse coronary sclerosis.
- Patients who are not fit for Angioplasty-Stent & / or Bypass surgery because of associated advanced extra-cardiac diseases like Renal failure, Hepatic failure or Pulmonary failure.
- Patients who are not willing for any surgical intervention because of their own wish or financial constraints.
The benefits of EECP therapy are documented by:-
A. Improvement in Symptoms: During EECP treatment, patient is asked for symptoms relief predicting:-
- Decrease in episodes & intensity of anginal pain
- Increase in work capacity in walking, climbing upstairs
- Betterment in overall wellbeing & sleep pattern
B. Improvement in Stress Thallium/ CTMT/ Echocardiography: Patient undergoes thes tests pre- & post-EECP treatment predicting:-
- Increase in Myocardial perfusion
- Increase in Exercise duration (METS)
- Increase in Ejection Fraction (EF)
EECP in Extra-cardiac Diseases:
EECP increases blood supply to all vital organs like Heart (20-42%), Brain (22-26%) & Kidneys (19-20%), that’s why it is not only effective in heart attack but also beneficial in palalysis (Ischemic Stroke), Dementia (multi-infarct), Parkinson’s disease and vascular renal diseases.
EECP in Prevention of Heart Attack:
EECP therapy is advised before bypass surgery to improve the myocardial function so as to decrease operative & post-operative complications, morbidity and mortality. On the other hand, it is also advised in post-angioplasty & post-CABG patients so as to avoid early stenosis of stents and blockages in bypass grafts.
The chances of heart attack increases by many folds in persons carrying two or more risk factors like Diabetes, Hypertension, Dyslipidemia, Obesity, Tobacco users or Stress. Preventive EECP therapy in this population can minimize the incidenc & intensity of heart attacks.
After getting popularity in USA, UK & European countries, EECP therapy is now being done successfully in reputed hospitals all over India.
DR.ASHOK GOYAL, MD
Bani Park Heart, EECP & General Hospital
D-9, Kabir Marg, Bani Park, Jaipur – 302016