External counterpulsation

Therapy (ECP) is a procedure performed on individuals with angina or heart failure or cardiomyopathy in order to diminish symptoms of ischemia.

It’s purpose is to improve functional capacity and quality of life.

Relieves angina, and decreases the degree of ischemia in a cardiac stress test.

While an individual is undergoing ECP, he/she has pneumatic cuffs on his or her legs and is connected to telemetry monitors that monitor heart rate and rhythm.

The most common type in use involves three cuffs placed on each leg, the calves, the lower thighs, and the upper thighs.

The cuffs inflate and deflate based on the timing of the individual’s electrocardiogram.

The cuffs ideally inflate at the beginning of diastole and deflate at the beginning of systole.

During the inflation of 200 mmHg the calf cuffs inflate first, then the lower thigh cuffs and finally the upper thigh cuffs.

This process decreases cardiac afterload that the heart has to pump against, and increases the preload that fills the heart, increasing cardiac output.

Works similarly to the intra-aortic balloon pump (IABP), increasing pressure in the aorta while the heart is is in diastole.

Increases blood flow into the coronary arteries, which also occurs during diastole.

Provides mechanical external cardiac resulting in significant improvement in energy and exercise tolerance much like an exercise program.

It is thought by restoring oxygenated blood flow it revives tissue in parts of the heart and body that have become stunned due to restricted or blocked blood flow.

The heart improvems in structure, contracility and a reduction in afterload due to the reduction in systemic vascular resistance.

Patients see improvements in symptoms of chest pain, shortness of breath, chronic fatigue as well as a significant improvement in exercise tolerance.

Candidates include: angina patients who are not relieved by medication.

Patients who don’t want to have bypass surgery

Patients who are contraindicated for bypass or angioplasty due to kidney failure, liver failure, severe COPD cases, diffuse diabetes disease, very old age, patients of Syndrome X, ischemic and dilated cardiomyopathy

Contraindications to external counterpulsation:

Severe aortic regurgitation or aortic stenosis

Deep vein thrombosis


Very high blood pressure

Severe peripheral vascular disease

Possibility of stroke

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