www.revivalheartcare.com
External Counter pulsation (ECP
Dr.Gulati , Revival Health Care , A-84,Lajpat nagar-II ,New Delhi ,Phone : 011-29840606, mobile : 9810414040
35 Sittings in 35 days , 1 hour each day , Rs.60,000/= package .
also visit,
http://www.strokedoctor.com/eecp1.htmThe Exciting Benefits of External Counterpulsation
External Counterpulsation (ECP) increases blood flow 22-26% to the carotid arteries to the brain(3,22), 20-42% to the coronary arteries (22), and 19% to the renal artery.(3) It increases the heart's output (stroke volume) by 12% and increases blood flow to areas not getting enough oxygen in the heart.(7) The ECP is FDA approved for Coronary Artery Disease and has been shown effective in the treatment of ischemic conditions, including glaucoma, angina, coronary artery disease, stroke and brain injury.(24)
The ECP is exciting state-of-the-art technology that is a safe, non-invasive method that improves circulation to the vital organs (heart, brain, kidneys, etc.) and its benefits can be maintained for 4-7 years after the therapeutic program.(2,12) Our patients report that it increases their energy, gives them more vitality for physical therapy, increases circulation to their feet, improves their sleep at night, and helps them be more alert and mentally focused.
In China, External Counterpulsation has been widely used since 1983 for heart disease as well as cerebrovascular disease.(22,24,25,26) In the United States, the predominant research with ECP has been for ischemic heart disease.
Ischemic heart disease is due to the lack of blood flow (and oxygen) to the heart which causes the symptoms of angina (chest pain). A chronic lack of oxygen to the heart causes a decrease in a decrease in a person's exercise capabilities, quality of life, and may result in a heart attack and/or stroke.
Until recently, the predominant treatment for ischemic heart disease was open heart bypass surgery. This treatment is costly, invasive, and associated with complications (including blood clots, infection and a 4% mortality rate). In addition, the health benefits of this surgical procedure are often temporary.
The ECP is an outstanding alternative for the person who cannot or will not have a bypass and the device produces numberous benefits to the ischemic heart, brain, kidneys and entire system. The equipment is safe, effective, and generally well tolerated, with few side effects or discomfort to the patients.
The benefits of ECP in patients with chest pain due to blockage of the heart blood vessels (angina pectoris), and heart attack with or without shock, that have been reported in the scientific literature include:
1) Increase in venous blood flow returning to the heart (7,8)
2) Increase in the resting phase of the heart beat cycle, which promotes greater oxygenation to the heart (7,17)
3) "Milks" blood flow from lower extremities which increases the filling of the heart and thereby increases cardiac output. In addition, there is increased blood flow to all other vital organs, including the brain and kidneys, without increasing the heart rate. (3,7,24)
4) The left ventricle of the heart has less to push against because of decreased peripheral resistance. This reduction in resistance increases the heart's performance and reduces its workload.(7,14)
5) Increases perfusion (blood flow) throughout the heart, eliminating or reducing myocardial ischemia (lack of blood flow and oxygen) (8,10)
6) Promotes the development of collateral blood vessels (blood vessels that develop along side or parallel to blocked or injured blood vessels) (7,9,11)
7) Reduces the frequency and intensity of angina symptoms (chest pain) (4,12)
8) Reduces ventricular fibrillation (rapid, convulsive movements of the heart muscles) (1,13)
9) Improves myocardial lactate removal (a build up of lactic acid causes muscle fatigue) (7)
10)Slows the progression to cardiac failure in those with cardiac insufficiency (1,13)
11)Increases exercise tolerance (4,8,9)
12)Improves the person’s sense of well being and overall quality of life (6,12)
13)Decreases the risk of heart attack (8,25)
14)Reduces the need for anti-anginal medication (12)
15)The positive effects are sustained between treatments and generally persist for several years after the end of the therapeutic program (2,9,12,25)
16)Usually well tolerated with no significant side effects (4,8)
These effects are dependent on there being at least one intact, functional blood vessel to the heart. The greater the number of blocked arteries, the less the benefit of ECP. In patients with single vessel obstruction, 95% had no sign of reclogging after the treatment program. In those with 2 vessel coronary artery disease, there was 90% improvement, and in those patients with 3-vessel disease, there was a 42% improvement.(11)
Brain Disorders Treated by the "Pump"
The Chinese have been using ECP to treat nervous system and ophthalmogy disorders as well as cardiovascular disease since the early 1980’s. Their indications for ECP include: (24,25)
1) Brain thrombosis (blood clotting that obstructs blood flow)
2) Lacunar brain infarction (lack of oxygen to small recesses of the brain)
3) Transient ischemic attack (short periods of reduced blood flow to the brain)
4) Blood supply shortage of the vertebro-basilar artery (an artery to the brain)
5) Cerebro-vascular dementia (memory loss due to lack of oxygen to the brain)
6) Cerebellar ataxia (irregularity and lack of coordination in cerebellar function)
7) Parkinsonism (condition characterized by muscular rigidity and tremors)
8) Vascular headache and migraine
9) Neuroasthenia - especially with insomnia (lack of strength and energy - low body temperature, loss of muscle tone, low blood sugar, fatigue and muscle pain)
10) Dizziness syndrome
How Does The "Pump" Work?
The "Pump" is coordinated with the heart beat. When our blood pressure is taken, we are given a "systolic" and "diastolic" reading, such as 120/70. To help you remember, think of the higher blood pressure as Superior and so the Systolic is the higher number. Scan also refer to Squeezing or to the contraction The systolic phase (systole - Greek for contraction) of the heart muscle is the contraction of the ventricles that drive the blood into the aorta and pulmonary artery. The diastolic phase (diastole - Greek for dilation) is the resting time between the contractions, when the ventricle fills with blood. The external counterpulsation equipment includes giant blood pressure cuffs around the legs that operate in synchrony with the person’s electrocardiogram. The cuffs inflate during the diastolic phase of the heart beat, "hugging" the legs and pushing the venous blood sequentially from the calves, thighs and buttocks towards the heart. This also increases oxygenated blood flow upwards, supplying greater blood flow to the coronary arteries(16)brain,liver and kidneys.(11,24,25)
The cuffs then deflate while the heart is contracting, which allows blood to flow easily into the legs. In fact, with the ECP returning more blood to the heart from the lower extremities, the left ventricle is pumping against less pressure in the legs. Therefore it takes less effort (and less oxygen demand) for the left ventricle to pump more blood to the system (reduced workload or reduced ventricular after load).(7,16)
The increased blood flow to the coronary arteries dilates (enlarges) the smaller blood vessels of the heart and this enlargement gradually increases their blood carrying capacity, creating collateral pathways around blocked and injured arteries. This process creates a "natural bypass" and is credited as being a major factor for the benefits of ECP lasting several years after the therapy has ended.
In summary, the "pump" increases oxygen supply to the heart while reducing its work load and oxygen demand. The use of ECP in a therapeutic program of one hour a day, five days a week for 35 sessions, revitalizes cardiac function, reduces angina symptoms, increases exercise endurance, improves the person’s quality of life, and reduces the risk of heart attack and stroke. In addition, there is increased circulation to all the vital organs, including the brain, liver and kidneys - resulting in the potential for improved function throughout the entire system. Clinical studies have indicated that 35 hours is the minimum while 60 hours is thought to give the best overall results.
Historical Perspectives
In 1953, Kantrowitz and Kantrowitz proposed the concept that elevations of diastolic pressure in the arteries could improve blood flow in the heart and be beneficial to patients with coronary insufficiency. (15)
In 1963, Dennis and coworkers used a pressure sleeve on the hind legs of dogs that was inflated and deflated in synchrony with their electrocardiogram.(7)
In 1968, Kantrowitz and associates demonstrated the principle of "phase shift", of increasing diastolic blood flow with the intra-aortic balloon pump in 27 patients.(3)
In 1969, Ruiz and associates evaluated the use of external pulsatile pressure to the lower extremities in five normal subjects. The aortic diastolic pressure was increased by 50 mm Hg with a 20% increase in cardiac output. In two patients with cardiogenic shock, an increase in perfusion pressure was associated with clinical improvement.(13)
In 1973, Cohen and associates investigated the effects of sequential (inflating the cuffs around the calves area, then thigh area, then buttocks in sequence) and non-sequential (uniform inflation) external counterpulsation in seven normal subjects. Diastolic augmentation was equivalent in both groups but cardiac output increased 17% with the sequential method. Cardiac output did not rise significantly with the uniform inflation method. The authors also compared sequential external counterpulsation to the Intra-aortic Balloon Pump (IABP) in experimental animals before and after inducing cardiac shock. Cardiac output was increased an average of 25% with external counterpulsation compared to 4% with IABP. The effects were due to an increase in venous return caused by the diastolic augmentation.(17)
In 1974, Harry Soroff and coworkers reported the results of early models of External Counterpulsation in 20 patients suffering from cardiac shock following a heart attack. Cardiac shock had a 15% survival rate, but 45% of Soroff’s patients survived; a significant increase in survival due to treatment with the ECP. Soroff originally used a device having a fiberglass leg unit with water-filled bladders that enclosed the patient’s lower extremities. It was hydraulically operated, triggered by the electrocardiogram signals, filling at diastole and emptying the bladders surrounding the legs at systole. (14,16)
In 1976, John Watson and his associates compared external counterpulsation and intra-aortic balloon pumping in anesthetized dogs. Both methods increased the amount of blood returning to the heart; but external counterpulsation also significantly increased collateral coronary blood flow to the ischemic heart tissue. External counterpulsation also had the advantage of being non-invasive.(21)
In 1976, a joint program of 11 Chinese medical centers and factories developed the first sequential external counterpulsation device, followed by clinical investigations. (25,26)
In 1977, Rene Langou and associates published a review paper, giving a historical perspective of ECP and explanation of the Tension Time Index (originally presented by Sarnoff in 1958) and how the ECP increases the rest period of the heart which maximizes oxygen extraction and oxygen delivery to the myocardium while reducing oxygen consumption (cardiac work load).(7)
In 1980, Ezra Amsterdam and coworkers published the clinical results of an early ECP device used for acute myocardial infarction in a prospective, randomized trail of 258 patients in 25 hospitals. Hospital mortality (6.5%; 7 of 108 patients died) was significantly reduced in those receiving 4 or more hours of ECP within the first 24 hours after admission. Mortality in the control group was 14.7 % (17 of 116 patients died). Patients receiving the external counterpulsation treatment showed a reduction in chest pain, decreased progression of cardiac failure, reduced ventricular fibrillation, a reduction in heart size and improved clinical cardiac functional status at discharge.(1)
In 1990, Yu-yun Xu and Zhen-sheng Zheng published a review article of research with ECP in China. At that time, the equipment was used extensively in over 1,800 research, clinic and hospital facilities. In the short term evaluation of 6,116 patients with Angina pectoris, 52.6% of the patients showed significant improvement in cardiac symptoms, 30.3% showed some improvement, 8% had no change and 2% deteriorated. Of the total number of patients, the procedure was effective in promoting improvement in 92% of the cases (5,630 out of 6,116). In another study of 5,067 angina cases, 20.5% showed significant improvement, 47.8% showed some improvement, 30.5% had no change, and 1.2% deteriorated. The total effective rate in this study was 68.3%. In the evaluation of long term effects 5-7 years after therapy, 102 patients treated with ECP were compared with 111 patients treated with medication. There was significant improvement in clinical symptoms in 67.79% of those treated with ECP compared to 38.74% of those treated with medication. There was also significant improvement in electrocardiogram results for 62.47% of the patients treated with ECP compared to 28.35% of those treated with medication. Mortality rates for cardiovascular disease for the ECP groups were 8.82% compared to 13.51% for the medication group. Acute myocardial infarction rates for the ECP groups were 2.94% compared to 8.11% for the medication group. ECP significantly improved clinical symptoms and electrocardiogram results and significantly reduced the risk of death and heart attack in an 8 year follow up. In 24 patients with cerebral ischemic disease, 54% showed significant improvement with ECP compared to 29% treated with medication. The total effective rate was 95.8% for the ECP group compared to 75% in the medication group. The author cautions that ECP not be used during the acute phase of cerebral ischemia or for hypertensive patients (those with blood pressures exceeding 160/100 mm Hg). external counterpulsation was also effective in treating sudden deafness and eye diseases (thrombus of the retinal artery, traumatic optic atrophy and optic neuritis).(25)
In 1992, William Lawson and associates studied 18 patients (aged 45-75) with chronic angina that persisted despite surgical and medical therapy. After 36 sessions (1 hr each) of External Counterpulsation, all of the 18 patients improved in their chest pain symptoms with 16 reporting complete relief. The treatment was usually well tolerated with less improvement seen in those with blockages in three vessels or with diffuse coronary artery disease. (8)
In 1995, Lawson published a three year follow-up of his 18 patients. Ten patients consented to being tested again. Of these, 8 continued to demonstrate improved myocardial perfusion (circulation). Two others returned to their pre-treatment baseline even though they showed clinical improvement in their symptoms. Lawson concluded that long term improvement in myocardial perfusion and exercise tolerance can occur several years after ECP therapy, probably due to its promotion of collateral circulation. (9)
In 1996, Lawson and his coworkers published an article on the effects of ECP on exercise hemodynamics and myocardial perfusion during a stress test in 27 patients with chronic stable angina. 81% (22 out of 27) of the patients improved their exercise tolerance after the ECP treatment and 78% (21 out of 27) improved on their radionuclide stress perfusion images. Because maximal heart rate did not significantly increase despite increased exercise duration, the authors suggest that the increase in exercise tolerance is due to improved mycardial perfusion and altered exercise hemodynamics. ECP therapy therefore appears to exert a "training" effect, decreasing peripheral vascular resistance and cardiac work load in coronary disease patients. (10)
In 1997, Applebaum and associates, using a two cuff protocol (leg and thigh), measured carotid artery flow in 35 patients (mean age 60) and renal artery flow in 18 patients (mean age 55). An increase in carotid and renal artery flow during diastole was observed in all patients. The mean carotid flow increased by 22%, from 27.7 ccm to 33.1 cm. The mean renal artery flow increased by 19%, from 21 cm to 25 cm. The pressure used was 150-180 mm Hg and all patients tolerated the procedure well without side effects. The authors conclude that ECP significantly increases carotid and renal blood flow and recommend the therapy to support those with decreased cerebral and/or renal circulation. (3)
Also in 1997, Fricchione studied the psychological aspects of external counterpulsation and found that the treatment significantly improved depression scores. Patients often report feeling depressed following invasive procedures. Since depression is associated with poor outcome in those with cardiac disease, external counterpulsation offers clinical advantages beyond its circulatory benefits. (6)
In the November, 1997 issue of the Cardiovascular Reviews and Reports, Dr. Strobeck and Dr. Tartaglia presented case studies of the effects of ECP on coronary artery disease. Stress scintigram images of pre- and post-treatment showed significant improvement in myocardial perfusion and a reduction in ischemia. (18,20)
In 1999, Arora and his coworkers reported on the results on a multicenter randomized, placebo controlled multicenter trial to evaluate external counterpulsation in 139 patients with angina, documented myocardial ischemia and coronary artery disease. The program consisted of 35 hours of treatment, with one hour sessions over a 4-7 week period. The authors concluded that the treatment was safe and effective in reducing angina symptoms in patients with coronary artery disease. The treatment was generally well tolerated and free of limiting side effects in most patients. Side effects that were reported included anxiety, dizziness, GI disturbances, arrhythmias, chestpain, edema, and skin abrasions. (4,5)
Also in 1999,Werner and associates investigated the changes in flow volume in the carotid, vertebral, hepatic, renal and internal iliac arteries after a one hour session with ECP in 16 healthy volunteers. The greatest increase in the carotid artery flow volume was 26%, seen in the three cuff method at a pressure of 300 mm Hg. The two cuff procedure at 200 mm Hg produced a 19% increase in blood flow to the carotid arteries. The three cuff method at 300 mm Hg increased blood flow 42% to the left main coronary stem compared to 18% in the two cuff method at 200 mm Hg. Werner concluded that the increase in blood flow to the coronary arteries leads to a significant increase in blood flow to the brain, liver, kidneys and myocardium. He also reported a 75-80% reduction in the vasocontrictive hormones endothelin and renin in both healthy volunteers and patients with coronary artery disease. (22)
Ozlem Soran and associates published a paper suggesting that the increase in shear stress by the ECP may result in the release of various growth factors which stimulate angiogenesis (growth of new blood vessels) in the coronary beds. Patients who responded favorably to chronic therapy with ECP showed a significant increase in circulating vascular endothelial growth factor (VEGF) which promotes endothelial cell migration and collateral blood vessel growth. (15)
The External Counterpulsation device is on the forefront of cardiac and cerebrovascular rehabilitation. We have an exciting opportunity at the Brain Therapeutics Medical Clinic to see how much improvement in brain repair can be obtained from the utilization of ECP added to our comprehensive program.
JOURNAL ARTICLES
1) Amsterdam, Ezra. "Clinical Assessment of External Pressure Circulatory Assistance in Acute Myocardial Infarction." AMERICAN JOURNAL OF CARDIOLOGY, 1980; 45: 349-356.
2) Amsterdam, Ezra. "Enhanced External Counterpulsation: Chronicle of a New Approach to the Theory of Angina Pectoris." CARDIOVASCULAR REVIEWS AND REPORTS; 1997; 15-19.
3) Applebaum, Robert et al. "Sequential External Counterpulsation increases Cerebral and Renal Blood Flow." AMERICAN HEART JOURNAL,1997; 133: 611-5.
4) Arora, Rohit et al. "The Multicenter Study of Enhanced External Counterpulsation (MUST-EECP): Effect of EECP on Exercise-Induced Myocardial Ischemia and Anginal Episodes." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1999,33(7):1833-1840.
5) Conti, R. "EECP-Enhanced External Counterpulsation." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1999; 33(7):1841-42.
6) Fricchione, Gregory et al. "Psychosocial Aspects of Enhanced External Counterpulsation." CARDIOVASCULAR REVIEWS AND REPORTS, 1997,18:37-41.
7) Langou, Rene et al. "The Sequential External Counterpulsator: A Circulatory Assist Device." YALE JOURNAL OF BIOLOGY AND MEDICINE, 1977; 50: 59-65.
8) Lawson, William. "Efficacy of Enhanced External Counterpulsation in the Treatment of Angina Pectoris." AMERICAN JOURNAL OF CARDIOLOGY, 1992; 70: 859-862.
9) Lawson, William. "Three Year Sustained Benefit from Enhanced External Counterpulsation in Chronic Angina Pectoris." AMERICAN JOURNAL OF CARIOLOGY, 1995, 75: 840-841.
10) Lawson, William et al. "Improved Exercise Tolerance Following Enhanced External Counterpulsation: Cardiac or Peripheral Effect?" CARDIOLOGY, 1996; 87: 271-275.
11) Lawson, William et al. "Can Angiographic Findings Predict Which Coronary patients Will Benefit from Enhanced External Counterpulsation?" AMERICAN JOURNAL OF CARDIOLOGY, 1996; 77: 1107-1109.
12) Lawson, William et al. "Enhanced External Counterpulsation: U. S. Clinical Research." CARDIOVASCULAR REVIEWS AND REPORTS, 1997, October, 18:18-22.
13) Ruiz, U. et al. "Assisted Circulation by External Pressure Variation." JOURNAL OF CARDIOVASCULAR SURGERY, 1969; 10: 187-197.
14) Scheidt, Stephen et al. "Mechanical Circulatory Assistance with the Intraaortic Balloon Pump and Other Counterpulsation Devices." PROGRESS IN CARDIOVASCULAR DISEASES, 1982; 25(1): 55-76.
15) Soran, Ozlem et al. "Enhanced External Counterpulsation in the Management of Patients with Cardiovascular Disease." CLINICAL CARDIOLOGY, 1999; 22: 173-178.
16) Soroff, Harry et al. "External Counterpulsation - Management of Cardiac Shock After Myocardial Infarction." JAMA, 1974; 229: 1441-1450.
17) Soroff, Harry et al. "Historical Review of the Development of Enhanced External Counterpulsation Technology and its Physiologic Rationale." CARDIOVASCULAR REVIEWS AND REPORTS, 1997; November: 34-40.
18) Strobeck, John et al. "The Emerging Role of Enhanced External Counterpulsation in Cardiovascular Disease Management." CARDIOVASCULAR REVIEWS AND REPORTS, 1997; November, 18: 6-11.
19) Suresh, K. et al. "Maximizing the Hemodynamic Benefit of Enhanced External Counterpulsation." CLINICAL CARDIOLOGY, 1998; 21: 649-653.
20) Tartaglia, Joseph. "Case Studies: Enhanced External Counterpulsation." CARDIOVASCULAR REVIEWS AND REPORTS, 197; November, 18: 12-17.
21) Watson, John et al. "Similaries in Coronary Flow Between External Counterpulation and Intra-aortic Balloon Pumping." AMERICAN JOURNAL OF PHYSIOLOGY, 1976; 230(16): 1616-1621.
22) Werner, Dierk et al. "Pneumatic Exernal Counterpulsation: A New Noninvasive Method to Improve Organ Perfusion." AMERICAN JOURNAL OF CARDIOLOGY, 1999; October 15, 84: 950-952.
23) Wright, Philip. "External Counterpulsation for Cardiogenic Shock Following Cardiopulmonary Bypass Surgery." AMERICAN HEART JOURNAL, 1975; 90(2): 231-235.
24) Wu, Hu Jian. "Probe to the Indications, Contraindications, Course and Therapeutic Effects of ECP-Treatment." CHINESE EXTERNAL COUNTERPULSATION JOURNAL, 1993; 5: 1-8. (Translated by Z. Huang, M.D., Los Angeles, August, 1995.)
25) Xu, Yu-yun and Zhen-sheng Zheng. "External Counterpulsation", CHINESE MEDICAL JOURNAL, 1990; 103(9): 768-771.
26) Zheng, Zhen-sheng et al. "Sequential External Counterpulsation (SECP) in China." TRANS AM SOC ARTIF INTERN ORGANS, 1983; 29: 699-603.
http://www.medical-library.net/specialties/framer.html?/specialties/_enhanced_external_counter_pulsation.htmlEnhanced External Counter Pulsation
Enhanced External Counter Pulsation (EECP) is a non-invasive way of assisting circulation which is rapidly coming to replace bypass surgery in many cases involving angina pectoris. It is a treatment for ischemic heart disease which improves heart function by enhancing circulation through the coronary vessels using a pressure suit which fits the lower half of the body.
"Enhanced" refers to the equipment that has evolved over decades of research and development to become the state-of-the-art treatment delivery system now used in EECP treatment centers. "External" means that treatment happens outside of the patient's body and doesn't require surgery.
The system compresses the legs from the ankles through the thighs and (optionally) buttocks sequentially by inflating three sets of flexible, fabric cuffs during the resting phase of the heart cycle (diastole). This results in the movement of blood from the legs toward the heart through both the arterial and the venous systems. Pressure is applied with the timing and duration of each pulse and is synchronized with the patient's heart beat. This transmits back pressure through the arterial system.
In other words, each wave of pressure is electronically timed to a heart beat, so that the increased blood flow is delivered to the heart at the precise moment it is relaxing. When the heart begins to contract again, pressure is released instantaneously. This lowers resistance in the blood vessels of the legs so that blood may be pumped more easily from the heart, decreasing the amount of work required of the heart muscle. During counterpulsation the EECP system pumps when the heart is resting and releases pressure when the heart is contracts.
The aortic valve, the valve located at that point where the blood leaves the large (left) ventricle, prevents back flow into the left ventricle. The coronary arteries come off the aorta just above the aortic valve so that the increased diastolic pressure which results from the counter pulsations applied to the lower extremities drives extra blood through the coronaries, thus expanding networks of tiny
auxiliary blood vessels, thereby increasing the amount of blood flowing to heart muscle. The therapeutic benefit which is seen over time is that new blood vessels form creating a natural bypass. This is thought to occur due to the release of "angiogenic" (i.e. vessel forming) growth factors.
The result of EECP is to speed up a process which is already happening: the development of collateral circulation. This is, however, a gradual process and not everyone has the same natural ability to develop these networks at a rate that will relieve symptoms.
The typical treatment regimen for chronic angina patients is 35 hours of treatment, usually one hour per day, five for days per week for seven weeks. Some patients choose a 2-hour per day regimen, which reduces the time to completion to 3-1/2 weeks. Treatment can be given lasting up to four hours, with a 10 minute rest period after each hour of treatment. The duration of treatment and rest intervals will depend on the patient's condition, the degree of diastolic augmentation obtained, patient tolerance and the indications for application of the device.
The following are indications for use for external counter pulsation therapy:
Acute Myocardial Infarction
Cardiogenic Shock (loss of blood pressure)
Angina Pectoris, both Stable and Unstable
Patients with varying degrees of left ventricular dysfunction have demonstrated improvement with external counter pulsation. These patients frequently show:
Less recurrent chest pain
Less ventricular fibrillation
Reduction or elimination of shock symptoms
Decrease in heart size (in cases where the heart has increased to an abnormal size)
Less progression to cardiac failure
Increased quality of life
Decreased mortality rates
Patients with normal left ventricular function but with coronary artery disease may benefit from External Counter Pulsation treatment in obtaining symptomatic relief of angina pectoris. The system may also be useful in emergency situations in place of dangerous invasive procedures, and in all situations where diastolic blood pressure augmentation may provide therapeutic benefits.
To find a doctor who offers Enhanced External Counter Pulsation,
click here. http://www.tribuneindia.com/2002/20020415/ncr3.htmAngina patients can avoid surgery
Tribune News Service
New Delhi, April 14
With the revolution in Enhanced External Counter Pulsation (EECP) system, heart patient can now avoid heart surgery, Health Minister of Delhi Government, Dr Ashok Walia said. Speaking at the opening of the Capital’s first EECP centre in East Delhi, Dr Walia said, "it is an open non-invasive out patient procedure to relieve angina by increasing the oxygen delivery to the heart muscles."
A noted cardiologist and former M.S. of GB Pant hospital, Dr M. Khalilullah said that using the EECP technique without surgery and angioplasty could decrease the severity and frequency of the angina. Moreover, this treatment could decrease the need for medication and improve the ability to participate in normal day to day activities.
Dr Khalilullah said that unlike bypass surgery and balloon angioplasty, the EECP can be administered in out patient session and carried no risk.
One of the pioneers of EECP in the country, Dr Shiv Shankar, said that this technique is very simple, has no side effects, was convenient as compared to angioplasty and bypass surgery and cost much less than the existing procedures, besides being completely non surgical in nature.
http://www.tribuneindia.com/2002/20020415/ncr.htm - hlthttp://www.expresshealthcaremgmt.com/20031130/criticaremgmt08.shtml
External Counter Pulsation to the rescue of heart patients
Dr (Col) Kulwant Sharma
To open up blocked heart arteries, bypass surgery was successfully carried out for the first time in 1966. Another non-surgical but invasive technique called coronary angioplasty (ballooning) appeared on the scene in 1977. But over the next decade or so, it was realised that the blockage quickly re-occurs due to the spongy nature of the fatty mass, after it has been compressed with ballooning technique.
Search for a solution to this intractable problem led to invention of stent, which could hold the fatty mass back. But now a new problem cropped up, that is, the metallic mesh being a foreign body, it provoked inflammatory reaction and led to the proliferation of local tissues. It also caused the blood to clot when it came in contact with the metallic mesh. So a brand new solution was created for this brand new problem, in the form of drug coated stent.
Yet, in every cardiology clinic there is an increasing population of patients who have persistent anginal symptoms even after they have tried multiple bypass operations and angioplasties. Analysis of accumulated research data over the past more than three decades has revealed some very disturbing findings: when the outcomes of the people who underwent bypass operation and those who underwent angioplasty were compared with those of the people who refused to undergo any of these invasive/ surgical procedures, there was found to be hardly any difference.
Almost the same number of people had suffered heart attacks and almost the same number of people died over the next ten years or more between the two groups. Clearly, patients are not benefiting from CABG and PTCA. But bypass operations and angioplasties are continuing to be performed with great flourish and in great numbers. Surely, at least some people must be benefiting?
Yes, some indeed are benefited, but rarely they are patients and usually they are the hospitals and the doctors. Extensive research has been conducted over the past few years to understand the reason behind this puzzling phenomenon-after all when blockages have been cleared away or bypassed and effective blood supply has been restored, why should heart attacks and deaths continue to take place more or less at the same rate as before?
An answer came from the dead people-those who had died of heart attacks. Post Mortem examination of their hearts revealed that more than 85% of the deaths had taken place NOT because of physical obstruction caused by deposits, but they had been caused by "Plaque Rupture", that is, bursting of the covering membrane of the fatty mass leading to triggering of massive blood clotting locally.
Another interesting finding to emerge from Post Mortem examinations was that it was discovered that blockages are not a localised phenomena. They are generalised, affecting the entire length of coronary arterial tree; less at some places and more at some places. If all the branches of coronary artery are arranged end-to-end, the resultant conduit will stretch for more than ten kilometers.
Therefore, a bypass here and an angioplasty (with a stent or two may be) there; will be a very truncated solution to a very complex problem. After these very disturbing findings surfaced, a crying need for some solution, which could tackle the problem across its daunting length & breadth. When all these exciting things like CABG (bypass), PTCA (angioplasty) and "Stents" and "Drug Eluting Stents" were taking place, another development was going on quietly, in the field of "external counter pulsation".
Research in this field started way back in 1953 and by mid 70s, the technique had been refined to such an extent that it had started showing promising results. But around the same time, the euphoria and hype created by bypass and angioplasty; due to their "glamour" and "quick fix" nature (and of course, very attractive scope for commercial exploitation); overshadowed this promising new technology.
But over the years, the sky high hopes raised by CABG and PTCA were belied and further refinements in the ECP technology raised new hopes. Finally, External Counter Pulsation got approval of USFDA in 1997 for treatment of Angina Pectoris and subsequently for the treatment of Acute Myocardial Infarction (heart attack).
Recently, it has even been approved for the treatment of Congestive Heart Failure (in CHF, pumping action of the heart becomes so weak that fluid starts accumulating upstream, in various organs). This non-invasive technique provides augmentation of diastolic blood flow and coronary blood flow similar to the intra-aortic balloon pump, utilising the serial inflation of three sets of cuffs which wrap around the calves, thighs and buttocks. Inflation and deflation are timed to the patient’s ECG; which is fed into a computer and the arterial pressure waveform thus created is monitored noninvasively, by applying an electronic monitor either on a ear lobe or on one of the fingertips.
The overall effect on blood circulatory status is such that it provides augmentation of diastolic blood pressure (during the heart’s resting phase). This leads to increase in coronary perfusion pressure. There is unloading of systolic (systole: heart’s beating/ contracting phase) cardiac workload also and therefore decrease in myocardial (myocardium: heart muscle) oxygen demand. Venous return increases and as a result, cardiac output (volume of blood pumped out by the heart in one minute) improves. History of research in ECP is very interesting. It is a remarkably simple but smart idea.
Researchers realised that heart gets its own blood supply during its resting phase, after supplying blood to the whole body during it’s contracting phase. Accordingly, search started for a mechanism to increase pressure of blood column at root of the aorta (the main artery carrying blood from the heart to supply the whole body).
One such was "Intra Aortic Balloon Pump", wherein; a balloon was positioned at the root of the aorta, by threading a catheter in through leg arteries, under x-ray monitoring. This balloon is then sequentially inflated and deflated through an external "pulsator", which operates on the basis of ECG input from the patient and fires an inflation at the beginning of Diastolic phase and fires a deflation at the end of the diastolic phase. This rhythmical inflation-deflation provides support to a week and failing heart.
Taking a cue from IABP, two brilliant scientists, Soroff and Birtwell first described how the application of a positive pressure pulse to the lower extremities during diastole could raise diastolic pressures by 40 to 50 per cent and lower systolic pressures by up to 30 per cent. Herein, lower limbs are looked upon as if they are fluid filled bags, filled with at least one and a half liters of blood and lower limb and abdominal arteries are used as conduits or pipes to transmit pressure to root of the aorta (When nature has given built in tubes to us in the form of arteries, why insert tubes from outside in the form of catheters?)
Inflatable cuffs when made to inflate in a sequential manner as already described above, lead to ’milking’ action on the blood column, resulting in formation of pressure wave travelling in retrograde fashion towards the heart.
State University of New York at Stony Brooks has conducted independent research and confirmed the efficacy and safety of ECP. Further boost to ECP has been given by the Multi-centre Study of Enhanced External Counterpulsation (MUST-EECP),External Enhanced Counter Pulsation-EECP is a brand name research study. Results of this study were presented at the annual scientific meeting of the American Heart Association in November of 1997 and published. Seven centres enrolled into this study: University of California, San Francisco Moffitt-Long Hospitals; Columbia Presbyterian Medical Centre; Yale New Haven Medical Centre; and Beth Israel Deaconess Hospitals of Harvard Medical School; University of Pittsburgh Medical Centre; and Grant/Riverside Methodist Hospitals of Columbus, Ohio.
Scientific research always leads from complexity to simplicity and from bigger to smaller and from more difficult to easier e.g. radio, television, computer and all such things. Similarly the ease of use and simplicity of ECP is a marvel of scientific research and technology. In the coming day, ECP is predicted to emerge as the treatment of choice for Coronary Artery Disease (Blocked heart arteries). Often people ask, "Why did it not occur to any one before?" But no idea ever surfaces before its time. The time of this smart new idea has now come.
The author is with Neovask Heartcare Centre, New Delhi. E-mail: kulwantsharma@hotmail.com
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