External Counter Pulsation (ECP)
Recently, my father’s uncle had an episode of angina. He is in his early 70s but he is a very active person and can walk faster than me and many others younger than him. He does all his chores himself and leads a very active lifestyle. For a couple of days, he had pain around his chest and the pain spread to his shoulder and arm. Due to COVID, he could not go to a larger hospital and consulted a neighborhood primary care physician. Based on the physician’s advice, an electrocardiogram (ECG) was performed. The ECG came out fine and it was concluded that the pain could be due to some indigestion or gastric type of issues. At night on the same day, he had pain again, felt dizzy and lost consciousness for some time. He had to be taken to a hospital. Fortunately, the hospital did not make him wait for a COVID test result.
The doctor at the hospital diagnosed his condition as angina. Angina is a type of chest pain caused by reduced blood flow to the heart. Angina is a symptom of coronary artery disease. Angina symptoms include chest pain and discomfort, possibly described as pressure, squeezing, burning or fullness. There could also be pain in your arms, neck, jaw, shoulder or back. Other symptoms that you may have with angina include: Dizziness, Fatigue, Nausea, Shortness of breath, and Sweating.
Angina is caused by reduced blood flow to the heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle isn’t getting enough oxygen, it causes a condition called ischemia. The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Heart (coronary) arteries can become narrowed by fatty deposits called plaques. Three types of angina:
- Stable angina. Stable angina is usually triggered by physical activity. When you climb stairs, exercise or walk, your heart demands more blood, but narrowed arteries slow down blood flow. Besides physical activity, other factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and trigger angina.
- Unstable angina. If fatty deposits (plaques) in a blood vessel rupture or a blood clot forms, it can quickly block or reduce flow through a narrowed artery. This can suddenly and severely decrease blood flow to your heart muscle. Unstable angina can also be caused by blood clots that block or partially block your heart’s blood vessels.
Unstable angina worsens and isn’t relieved by rest or your usual medications. If the blood flow doesn’t improve, your heart is starved of oxygen and a heart attack occurs. Unstable angina is dangerous and requires emergency treatment. - Prinzmetal’s angina. This type of angina is caused by a sudden spasm in a coronary artery, which temporarily narrows the artery. This narrowing reduces blood flow to your heart, causing severe chest pain. Prinzmetal’s angina most often occurs at rest, typically overnight. Attacks tend to occur in clusters. Emotional stress, smoking, medications that tighten blood vessels (such as some migraine drugs) and use of the illegal drug cocaine may trigger Prinzmetal’s angina.
Angina can be reduced or prevented by reducing heart disease risk factors through lifestyle changes like
- Not smoking
- Eating healthy meals with limited saturated fat and more fruits and vegetables
- Safe exercise levels
- Maintaining healthy body weight
- Keeping medical conditions like diabetes, high blood pressure, high cholesterol under control
- Reducing stress
Lifestyle changes and medications are mandatory in the treatment of angina. Some patients may need medical procedures like Angioplasty and stenting, Coronary Artery Bypass surgery. For some patients, a non-invasive procedure called ECP along with lifestyle changes and medications provides significant improvements in angina symptoms leading to increased quality of life.
External Counter Pulsation (ECP) is a non-invasive, clinically proven therapy that is used to relieve discomfort and improve the quality of life. ECP therapy improves the circulation to the heart muscle, increasing oxygen-rich blood flow to the heart and reducing the heart’s workload. It can help to build new pathways around the blocked arteries in the heart by expanding networks of tiny collateral blood vessels that facilitate blood flow to the heart muscle.
ECP is a simple and comfortable procedure. Pneumatic cuffs, similar to blood pressure cuffs, are wrapped around the muscular areas of the patient’s calves, thighs and buttocks. Hoses connect the cuffs to an air pressure/vacuum pump enclosed within the bed base. The patient will feel the sensation of a strong hug moving upward from the calves to the thighs to the buttocks as the cuffs inflate and deflate. Each cycle is electronically synchronised with individual heart-beats. The patient will be able to relax and talk to visitors, watch TV, listen to music and radio or even take a nap during the hour long procedure. A typical course of treatment requires 35 one-hour sessions administered once daily, five/six days a week. Many patients report improvement after as many as 10 treatment sessions.
- Cuffs inflate rapidly from the calves towards the thighs, initiating pulse waves.
- Cuffs inflation continues, forcing fresh oxygenated blood towards the coronary arteries.
- Inflation around upper thighs sends higher volume of blood to the heart as pressure increases.
- Heart prepares for ventricular contraction; computer instructs the deflation of valves.
- Rapid release of pressure as the cuffs deflates, facilitates cardiac unloading.
ECP has been used in the treatment of angina for the past two decades with a record of safety and, more recently, several publications which support its efficacy. It is approved by the FDA for the treatment of chronic or unstable angina and in patients with congestive heart failure. Treatment has been associated with improved exercise tolerance.
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