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EECP: A hope for patients with coronary heart disease
Dr Kamal Cheema
 In
recent times, heart-related problems have shown a sharp rise to the extent that
today every family needs to be aware of their causes and the various treatment
options.
Coronary bypass surgery has been the traditional option for those with serious
coronary heart disease. Angioplasty is an appropriate and popular procedure
for less advanced cases and has the advantage that of being non-surgical and
less invasive.
Due to constant developments in technology and techniques, these traditional
treatments have brought immense benefit to patients over the years. However,
as the underlying process of plaque formation is not altered, many patients
had to undergo repeat bypass procedures, each time carrying a higher risk. For
these and other reasons, there is a growing segment of patients for whom bypass
surgery or angioplasty may not be suitable, and hence the need for alternatives
arises. The latest breakthrough in cardiac treatment is EECP - Enhanced External
Counter Pulsation - a comfortable and risk free treatment for certain cases
of coronary artery disease as well as congestive cardiac failure.
About coronary heart disease
Coronary heart disease (or coronary artery disease) refers to a narrowing of
the coronary arteries, the small blood vessels that supply blood and oxygen
to the heart. Narrowing usually results from the build up of plaque. As the
coronary arteries narrow, the flow of blood to the heart can slow or stop causing
chest pain, or angina (the commonest symptom), shortness of breath, heart attack,
or other symptoms. The symptoms associated with coronary heart disease may vary
from pronounced to barely noticeable.
About congestive cardiac failure
Congestive heart failure devastates millions of lives. Seen at all ages, it
is commonest in the elderly. Current treatment options relieve but never eliminate
the symptoms of which; angina, swelling of extremities, breathlessness and fatigue
are the commonest.
EECP: A non-invasive, outpatient treatment
Unlike procedures such as bypass surgery, balloon angioplasty, and stents, EECP
is entirely non-invasive (involves no surgery, drugs or needles), carries no
risk, is comfortable, and is administered in an outpatient setting. In fact,
EECP can feel like a deep muscle massage to the legs and the patient is completely
relaxed during the process.
EECP is administered as an out-patient procedure, making
it very convenient for the patient and the family. A course of therapy involves
35 consecutive (six times a week) one-hour sessions, during which the patient
lies on a comfortable bed and has blood pressure-type cuffs wrapped around his
calves and thighs. Cardiac monitoring leads are attached to the chest to record
the heartbeat. The EECP pumping console then rapidly inflates and deflates the
leg cuffs in time with the heartbeat.
Benefits of EECP
The benefits of EECP derive from its ability to create new pathways [collaterals]
around blocked arteries. This "natural bypass" happens as blood in
the legs is pumped back at high pressure to feed the heart muscle, using cuff
inflation.
Applied over time, EECP reduces angina frequency, improves a person's exercise
capacity and may result in reduced need for medication.
The now-famous, randomized, double-blinded, placebo controlled
MUST-EECP study, conducted at major university centers including Harvard, Yale
and Columbia, showed that approximately 80 percent of patients undergoing a
course of EECP had sustained clinical benefit one year later. Subsequent follow-up
after the one-year study shows continuing benefit up to the present [five years
after the initial study].
It is emphasized that EECP is not a replacement for bypass surgery or angioplasty,
but is an alternative treatment for those who can no longer benefit from additional
surgery or angioplasty, and for whom medical therapy has already been maximised.
EECP will benefit whom?
Nearly everyone with coronary artery disease can benefit from EECP.
It is particularly well-suited to people who:
- Have already had angioplasty, stents or bypass
surgery, and the heart disease symptoms have returned or persisted
- Are not candidates for surgery due to other serious
medical conditions
- Do not want to undergo surgery or angioplasty
- Rely heavily on medicines, or have to curtail their
activities to avoid angina and other heart disease symptoms
- Wish to explore alternative therapy with a lower
financial burden
For patients who have undergone multiple invasive procedures and for whom additional
surgery carries excessive risk, EECP treatment may be the only way to obtain
relieve from crippling angina.
The author is medical superintendent at Prince Aly Khan Hospital, Mumbai
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