Enhanced external counterpulsation

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Enhanced External counterpulsation therapy (EECP) is a procedure performed on individuals with angina or heart failure or cardiomyopathy in order to diminish their symptoms ischemia, improve functional capacity and quality of life. In various studies, EECP has been shown to relieve angina,[1][2] and decrease the degree of ischemia in a cardiac stress test.[2][3]



While an individual is undergoing EECP, one has pneumatic cuffs on his legs and are connected to telemetry monitors that monitor their heart rate and rhythm. The most common type in use involves three cuffs placed on each leg (on the calves, the lower thighs, and the upper thighs (or buttock)). The cuffs are timed to inflate and deflate based on the individual's electrocardiogram. The cuffs should ideally inflate at the beginning of diastole and deflate at the beginning of systole. During the inflation portion of the cycle, the calf cuffs inflate first, then the lower thigh cuffs and finally the upper thigh cuffs. Inflation is controlled by a pressure monitor, and the cuffs are inflated to about 200 mmHg.

When timed correctly, this will decrease the afterload that the heart has to pump against, and increase the preload that fills the heart, increasing the cardiac output.[4] In this way, EECP is similar to the intra-aortic balloon pump (IABP). Since it increases pressure in the aorta while the heart is relaxing (during diastole) EECP also increases blood flow into the coronary arteries, which also occurs during that phase.

Physiological considerations

One theory is that ECP exposes the coronary circulation to increased shear stress, and that this results in the production of a cascade of growth factors that result in angiogenesis.[5]


  1. ^ Zheng ZS, Li TM, Kambic H, et al. (1983). "Sequential external counterpulsation (SECP) in China". Trans Am Soc Artif Intern Organs 29: 599–603. PMID 6673295. 
  2. ^ a b Arora RR, Chou TM, Jain D, et al. (June 1999). "The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of ECP on exercise-induced myocardial ischemia and anginal episodes". J. Am. Coll. Cardiol. 33 (7): 1833–40. doi:10.1016/S0735-1097(99)00140-0. PMID 10362181. http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(99)00140-0. 
  3. ^ Lawson WE, Hui JC, Zheng ZS, et al. (1996). "Improved exercise tolerance following enhanced external counterpulsation: cardiac or peripheral effect?". Cardiology 87 (4): 271–5. doi:10.1159/000177103. PMID 8793157. 
  4. ^ Werner D, Schneider M, Weise M, Nonnast-Daniel B, Daniel WG (October 1999). "Pneumatic external counterpulsation: a new noninvasive method to improve organ perfusion". Am. J. Cardiol. 84 (8): 950–2, A7–8. doi:10.1016/S0002-9149(99)00477-4. PMID 10532522. http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(99)00477-4. 
  5. ^ Soran O, Crawford LE, Schneider VM, Feldman AM (March 1999). "Enhanced external counterpulsation in the management of patients with cardiovascular disease". Clin Cardiol 22 (3): 173–8. doi:10.1002/clc.4960220304. PMID 10084058. 
    Manchanda A, Soran O (October 2007). "Enhanced external counterpulsation and future directions: step beyond medical management for patients with angina and heart failure". J. Am. Coll. Cardiol. 50 (16): 1523–31. doi:10.1016/j.jacc.2007.07.024. PMID 17936150. http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)02392-3. 

See also