Enhanced external counterpulsation (EECP) is a relatively new, noninvasive treatment for angina and heart failure. Angina is a type of temporary chest pain, pressure or discomfort that is the main symptom of coronary artery disease – a chronic disease in which there is a “hardening” (atherosclerosis) of the coronary arteries. The pain associated with angina is caused by a temporary lack of oxygen-rich blood in the heart muscle. Heart failure is a condition when the heart muscle becomes weak and enlarged, and the heart cannot pump enough oxygen-rich blood to satisfy the body.

Enhanced external counterpulsation got its name because it is a sophisticated technique for producing counterpulsation without invading the body. Counterpulsation is a strategy for increasing the blood flow back to the heart during the part of the heartbeat (diastole) when the heart is relaxing between contractions. Not only does the strategy increase the amount of oxygen available to the heart, but it also decreases the heart’s workload, improves circulation and strengthens the cardiopulmonary system.

As a result, patients may experience a reduction in the frequency and intensity of angina and need less medication. Patients may also be able to increase their level of exercise (while under the supervision of a physician). Improvement can also carry over into other areas, such as ability to work, resuming of social activities and general sense of well-being. It has also shown benefit in patients with stabilized heart failure, although this use of EECP is very new and more long-term studies are underway.

Researchers are unclear about exactly how EECP continues to relieve the pain, pressure or discomfort of angina in the long run. The most supported theory appears to be the idea that EECP triggers a natural process in which the body produces tiny blood vessels (collaterals) that carry blood flow around blocked vessels. With more blood vessels available to carry oxygen-rich blood to the heart, angina is relieved.

Unfortunately, only certain patients are candidates for EECP. Patients who may be considered for EECP including those who:

Patients who do not qualify include those with the following conditions:

• Unpredictable chest pain (unstable angina)
• Major damage to the heart muscle
• Serious valvular heart diseases (e.g., significant aortic regurgitation)
• Atrial fibrillation or frequent extra heartbeats
• Uncontrolled high blood pressure (hypertension)
• Severe artery or vein disease in the legs
• Tendency to bleed excessively (including those with ulcers)
• Pregnancy

In addition, EECP may not be advised for people with pacemakers, implantable cardioverter defibrillators (ICDs) or patients taking anticoagulants. EECP is not likely to replace the more invasive techniques used to treat angina, but it may provide an option for certain patients who are not appropriate candidates for procedures such as balloon angioplasty or open–heart surgery. It may also provide an alternative for those who had those procedures, or who took medication, but continue to have pain.