What is EECP Treatment - Non Invasive Cardiac Care

Overview - What is EECP Treatment?

Enhanced External Counterpulsation (EECP) is a safe and non-invasive treatment designed to alleviate chest pain and improve shortness of breath. It is a gentle, outpatient therapy that does not rely on medication or surgery, making it a low-risk option with minimal to no side effects. Approved by the FDA and endorsed by American and European cardiology associations, EECP is a proven approach to enhancing heart health without pain or significant risks.

• E – “Enhanced”: Represents advanced progress made possible by cutting-edge clinical and technological innovations.
• E – “External”: Highlights that the treatment is entirely non-invasive, operating externally without surgical procedures.
• C – “Counter”: Refers to the core principle of the therapy: working against the heart’s natural pumping rhythm. When the heart contracts, specially placed cuffs on the legs relax, and when the heart relaxes, the cuffs gently compress.
• P – “Pulsation”: Signifies the rhythmic flow of blood through the arteries, a key aspect of how the treatment works.

EECP History in India

The journey of Enhanced External Counterpulsation (EECP) treatment in India has been marked by significant milestones:

• 1961: The first bypass surgery was performed, setting the stage for advancements in cardiac care.
• 1977: Introduction of balloon angioplasty, a breakthrough in minimally invasive heart treatments.
• 1997: Establishment of the first EECP treatment center globally, paving the way for non-invasive cardiac therapies.
• 2001: EECP made its debut in India with the first center opening in Bhopal, led by Dr. S. Ramasamy.
• 2010: The Indian Heart Journal published its first review article on EECP, authored by Dr. S. Ramasamy, elevating awareness about the therapy.
• 2015: Insurance coverage for EECP was introduced, and the Tamil Nadu government launched an EECP treatment program designed by Dr. S. Ramasamy.
• 2018: EECP was featured in a chapter of a cardiology textbook for the first time, written by Dr. S. Ramasamy.
• 2020: The first textbook dedicated entirely to EECP was published, authored by Dr. S. Ramasamy, solidifying its importance in cardiac care.

This timeline reflects the remarkable strides made in integrating EECP into India’s healthcare landscape, largely driven by the pioneering efforts of Dr. S. Ramasamy.

Who Can Benefit from EECP?

Enhanced External Counterpulsation (EECP) is a non-invasive therapy primarily used to improve blood flow and alleviate symptoms of cardiovascular conditions. The therapy involves the application of cuffs around the legs that inflate and deflate in sync with the patient’s heartbeat, enhancing blood flow to the heart and reducing its workload.

Groups of People Who Can Benefit:

1. Patients with Coronary Artery Disease (CAD):
   • Those with angina (chest pain) who are not responding well to medications or are not candidates for invasive procedures like angioplasty or bypass surgery.
   • Individuals with recurrent angina after prior interventions (e.g., stents or bypass surgery).
2. Heart Failure Patients:
   • People with chronic heart failure, particularly if they have reduced left ventricular function and seek improved exercise capacity and quality of life.
3. Individuals with Microvascular Angina:
   • Patients whose chest pain is caused by small vessel disease rather than blockages in major coronary arteries.
4. Patients with No-Option Angina:
   • Those who cannot undergo further surgical or interventional treatments for angina and are looking for symptom relief.
5. People with Peripheral Artery Disease (PAD):
   • EECP may improve circulation in individuals with reduced blood flow in the extremities, alleviating symptoms like leg pain and discomfort.
6. Post-Heart Attack Recovery:
   • Patients recovering from a heart attack may use EECP to enhance blood flow and cardiac recovery.
7. Athletes or Healthy Individuals (Occasionally):
   • Some use EECP for its potential cardiovascular benefits and performance enhancement.

Features of EECP Treatment

Enhanced External Counterpulsation (EECP) treatment offers unique features that make it a beneficial option for certain cardiovascular conditions. These include:

1. Non-Invasive Procedure:
   • No surgery, needles, or incisions are required.
   • Treatment is performed externally using cuffs wrapped around the legs.
2. Synchronization with the Heartbeat:
   • EECP devices are synchronized with the patient’s cardiac cycle using an electrocardiogram (ECG) signal.
   • Cuffs inflate during diastole (when the heart relaxes) and deflate during systole (when the heart pumps), optimizing blood flow.
3. Enhanced Blood Flow:
   • Inflation of the cuffs pushes blood back toward the heart, improving oxygen supply to the coronary arteries and reducing the heart’s workload.
   • Promotes the opening of collateral blood vessels, creating natural bypasses around blocked arteries.
4. Outpatient Treatment:
   • Sessions are conducted in a clinical setting, usually lasting about 1 hour.
   • Typical treatment plans involve 5 days a week for 7 weeks (35 sessions total).
5. Comfort and Adjustability:
   • The cuffs are adjustable to ensure patient comfort.
   • The intensity of inflation and deflation is modulated for individual needs.
6. Safe and Well-Tolerated:
   • Suitable for many patients, including those who cannot undergo invasive procedures.
   • Side effects are minimal and might include mild skin irritation or muscle soreness.
7. Benefits for Multiple Conditions:
   • EECP improves symptoms of angina, heart failure, and peripheral artery disease.
   • Enhances overall cardiovascular health by improving oxygen delivery and reducing cardiac workload.
8. Potential Long-Term Benefits:
   • Symptom relief can last for years after completing the treatment.
   • Regular sessions can lead to increased exercise tolerance and improved quality of life.
9. FDA-Approved and Evidence-Based:
   • EECP is FDA-approved for refractory angina and heart failure.
   • Studies demonstrate its efficacy in enhancing blood flow and reducing symptoms of ischemic heart disease.
10. Patient-Centric Approach:
    • Customized for individual cardiac needs and patient comfort.
    • Patients remain awake and comfortable during sessions, facilitating easy monitoring by healthcare providers.

How EECP is Done?

Enhanced External Counterpulsation (EECP) is a non-invasive treatment performed in a clinical setting. Here’s a step-by-step overview:

1. Preparation:
   • Initial Assessment: Medical history review, ECG, and blood pressure checks to ensure suitability.
   • Clothing: Patients wear comfortable clothing, or special pants may be provided to minimize skin irritation.
   • Positioning: Patients lie on a padded treatment table in a relaxed position.
2. Placement of Cuffs:
   • Cuffs are wrapped around the calves, thighs, and sometimes the lower abdomen.
   • These cuffs are connected to an EECP machine, controlling inflation and deflation cycles.
3. Monitoring:
   • An ECG monitors the patient’s heartbeat in real-time.
   • A finger sensor tracks blood oxygen levels and pulse.
   • Blood pressure is frequently checked for safety.
4. Inflation and Deflation:
   • Inflation: Cuffs inflate sequentially during diastole, pushing blood toward the heart to improve coronary blood flow.
   • Deflation: Cuffs deflate rapidly before systole, reducing resistance against the heart’s pumping action.
5. Duration of a Session:
   • Each session lasts about 1 hour.
   • Patients typically undergo 35 sessions over a 7-week period, 5 days per week.
6. Patient Experience During the Session:
   • Patients remain awake and can read, watch TV, or listen to music.
   • The inflation and deflation cycles feel like firm, rhythmic squeezing but should not be painful.
   • Adjustments are made for comfort if needed.
7. Post-Treatment:
   • Patients can resume daily activities without restrictions.
   • Mild side effects, such as muscle soreness or skin irritation, may occur but typically resolve quickly.

Key Safety Features:

• Continuous monitoring ensures synchronization with the heart’s rhythm.
• Medical professionals are present to address any concerns or make adjustments.

EECP is a painless and convenient procedure providing significant benefits for individuals with cardiovascular conditions, enhancing blood flow and improving overall heart function.