Value Add

Is Painful Angina Ruining Your Lifestyle?

Nandini Shah

"Usage of uncertified low cost ECP equipment produces no results, but it puts the life of the patients in major risk" - S Senthil Kandeepan Director Cardiopulse Heart Care

A non-surgical treatment for angina is available in India

By 2010, 60 per cent of world's heart patients are expected to be in India, according to the study conducted by St John's National Academy of Health Sciences, Bangalore, which appeared recently in the prestigious British medical journal Lancet. What is more alarming is the fact that in India problems of the heart is increasingly striking younger people. As the rate of heart diseases going high everyday, millions of people with the history of chest pain, angina or heart attack, invasive angioplasty or surgery have been their only choice. But now there is a safe and effective, non-drug, non-surgical alternative that can put them back into their active lifestyle is available.

Nicore External Counterpulsation (ECP)

This relatively new therapy, Nicore Advantage External Counterpulsation (ECP), an innovative, US FDA certified non invasive treatment option is now available in India. ECP provides an opportunity to treat and improve the quality of life for 'no option' angina and Congestive Heart Failure (CHF) patients who are refractory to medications and those who are non-surgical candidates. Clinical studies have demonstrated that ECP therapy benefits more than 80 per cent of patients treated, with significant improvement in relief of the symptoms, increased functional capacity and reduced dependence on medication. Clinical studies at top-rated hospitals including Yale, Columbia Presbyterian in New York City, University of California San Francisco, University of Pittsburgh and Harvard Deaconess Hospital, have demonstrated both the safety and efficacy of ECP. In addition, the Nicore ECP therapy system has been reviewed and approved by FDA. To date Nicore ECP has been performed on thousands of patients across the world with results indicating outcomes in excess of five years. These outcomes were fewer episodes of angina, elimination or subsiding of chest pain, increased exercise tolerance, decreased or elimination of anti-anginal medications and a return to more active lifestyle.

How Does ECP Work?

A computer interprets the patient's ECG and provides timing signals that control the sequential inflation and deflation of pressure cuffs wrapped around the patients calves, thighs and buttocks. Each inflation cycle is timed to start and end during the resting phase of the patient's heartbeat (diastole). As diastole begins, the cuffs inflate rapidly and sequentially from the calves to the buttocks, firmly compressing the patient's vasculature. This has two immediate effects- One, a strong retrograde 'counter-pulsation' occurs in the arterial system, forcing fresh oxygenated blood back towards the heart and coronary arteries and two, an increased volume of venous blood is returned to the heart under increased pressure. The combined effect of these two events is to increase the oxygen supply and perfusion pressure in the myocardium (heart muscle) and an increase 'per-load' so the heart has a greater volume of blood to pump during the next systolic event. Next, as the patient's heart nears the end of diastole and prepares for systole (ventricular contraction), the computer instructs the deflation valves to open, so a vacuum can deflate the cuffs instantly. This action also provides therapeutic advantages by reducing the heart's after-load. Since the vascular beds in the lower extremities are essentially empty, the resistance to blood flow is markedly reduced, thereby decreasing the amount of work that the heart must do to pump blood to these areas (reducing oxygen demand within the myocardium). As a result of these diastolic augmentation activities, the patient's peak diastolic pressure is significantly increased, benefiting circulating in the heart muscle and in other organs as well. At the same time, the patient's systolic pressure is reduced, to the general benefit of the vascular system. Clinical studies suggest that the increase in myocardial perfusion pressure stimulates the use of collateral vessels that are already present, but unused, there by allowing oxygenated blood to bypass ischemic areas in the heart.

Who Does it Work Best for?

For many angina and CHF sufferers, ECP therapy may be a preferred alternative to bypass surgery, angioplasty, stenting or medication. ECP may be indicated for patients who have already had, or are not good candidates for, surgical intervention. It is often an ideal choice for stable angina patients with single or multiple vessel coronary artery disease. In some cases, patients may be able to improve coronary circulation and perfusion pressure before a scheduled bypass surgery.

The treatment is also useful for patients who do not tolerate or those who prefer not to rely on medication. ECP may be inadvisable for patients with certain conditions, including recent surgical intervention, uncontrolled arrhythmia, pacemaker, severe pulmonary disease, severe hypertension, aneurysms, pregnancy or the presence of a burn, open wound or fracture on any limb subject to ECP treatment.

Benefits

Most patients report that after the full course of treatment the angina symptoms are reduced or eliminated and they have a great tolerance for exercise. Their social activities are no longer restricted and their dependence on anti-angina medications is lessened or eliminated. In addition to the subjective benefits of a more active lifestyle, ECP has been shown to provide long-term relief from angina symptoms. Although it is difficult to foresee how long the effects of ECP will last in an individual patient, studies show that the majority of patients sustain their ECP benefits for as long as five to six years. ECP therapy provides benefits that a physician can use to determine the effectiveness of treatment. Benefits are easily measured by response to exercise stress testing and radionuclide imaging. (For example, Thallium 201 imaging can clearly depict the increase in perfusion to previously ischemic areas of the heart.

Duration of Treatment

A prescription for ECP treatment normally specifies a total of 35 hours of therapy, administered for one hour per day, six days a week. Although most patients begin to experience relief from their angina symptoms after 12 - 13 hours of treatment, some patients may require additional weeks of treatment before the angina symptoms are resolved. Because ECP is totally non-invasive and non-pharmacological, the risks associated with the treatment are extremely low. The most commonly reported side-effects are skin irritation or temporary muscle aches, resulting from the inflating and deflating action of the pressure cuffs.

Uncertified Equipment Risks

The US FDA reviews the clinical trial, treatment accuracy, patient safety etc and certifies the intended use of any medical equipment to be used in the treatment. ScottCare Nicore ECP equipment is one amongst very few equipment cleared by the US FDA as ECP equipment to be used in the treatment of Coronary Artery Diseases (CAD). Usage of any other equipment which claims itself as ECP, its authenticity needs to be verified before putting in use or getting treated. Usage of uncertified low cost ECP equipment produces no results, but it puts the life of the patients in major risk.

The writer is S Senthil Kandeepan Director Cardiopulse Heart Care