Alternative to Bypass Surgery

About EECP August 26, 2008


EECP(ECP) or Enhanced External Counter Pulsation is a modern machine designed in USA and approved by USDFA for treatment of heart disease arteries. It increases blood flow to the diseased arteries by 200% and opens up collaterals. Thus it relieves chest pain and difficulty in breathing. The patient can walk longer, breathe easier and have a much better quality of life. The five year survival rate is the same for surgery, stents and EECP(ECP). Who can benefit from EECP(ECP) ?

Those who have been advised bypass surgery and choose not to have it.

Those who cannot afford the cost of bypass surgery.

Those who have other diseases which make them unfit for surgery eg. coexisting Diabetes Mellitus, Bronchial Asthma, Kidney failure, Thyroid disorders, old age i.e. more than 80 yrs.

Those who have already had bypass surgery done a few years earlier and don’t want to suffer the experience again.

Those patients who cannot afford the exorbitant cost of angioplasty (upto Rs 3.75 lacs with two cipher stents and reopro).

Those patients who have chest pain or breathlessness of cardiac origin and do not wish to undergo any further investigation can go for EECP(ECP) directly.

Patients whose stents have got blocked again.

How does EECP(ECP) work?

Actually it is quite simple. The patient lies comfortably on a couch in an A/c room. The legs, thighs and buttocks are enclosed in rubber bladders like those in a BP cuff. Three electrodes are placed on the chest wall to monitor the heart rhythm. One sensor is placed on the index finger or earlobe to monitor the pulse wave. The machine is then started and it sends pressure waves to the air bladders synchronized with the heart beats in such a way that when the heart contracts, a negative pressure wave is sent through the legs so the blood meets with very little resistance. When the heart relaxes (during diastole) positive pressure waves send the blood back to the heart in a more effective manner. So the coronary perfusion is increased by 200%.This causes the collapsed collaterals to reopen and provide blood to areas starved of oxygen. In brief EECP(ECP) results in

Increased diastolic perfusion pressure.

Increased coronary perfusion.

Increased coronary collateral flow to ischemic regions of myocardium.

Decreased ventricular load.

Increased venous return.

How does the patient know it benefits him ?

Patient starts feeling better in 3-5 days.His chest pain become less & his difficulty in breathing becomes better.

He can walk longer distances without onset of chest pain. His daily need of sub lingual nitrite tablets (sorbitrate or GTN) reduces dramatically.

TMT or exercise test is done before and after EECP(ECP). The ST segment depression seen before is markedly decreased eg. a 2-3mm ST depression can easily become 0.5-1mm after 35 days of EECP(ECP). The patient who could exercise say 4mins on the treadmill earlier can now exercise 10 mins without onset of chest pain or breathlessness.

Echocardiography is done before and after EECP(ECP). Ejection fraction or the efficiency of the heart improves from say 25% to 40% after 35 days of treatment.

There may be visible improvement in the ECG in the form of heart rate, ST segment depression & ectopics.

Stress thallium done before and after shows improved perfusion i.e. blood flow can be seen in those areas of the heart which were earlier starved of blood. Thus we see a marked improvement in almost all parameters of cardiac function measured before and after EECP(ECP).

So the good effects of EECP(ECP) can not only be felt by the patient but can also be demonstrated to his relatives and his treating Physician.

Cost of treatment (comparison)

EECP(ECP) is available in the most advanced Medical Cardiac centers like
The Cleveland Clinic
John Hopkins Medical center.
Texas Heart Institute
The Mayo Clinic
JKF Medical Center Atlantis
BIMC New York city
University of California San Diego

In London the cost is $12,000 and the waiting list is huge ref. The Sunday Express dtd. March 7th 2004

In Randhawa Hospital Amritsar, the total package cost is $ 2,500 only This includes 35 1hr EECP(ECP) sittings + complete blood tests including lipid profile, TMT test, and ECHO done before and after EECP(ECP). Arrangement for accommodation can be made within the hospital @ US$ 30/day AC, @ US$ 50/Day in 3 Star Hotel within 800 Meters of the Hospital or @ US$ 70/Day in 4 Star Hotel within 2km


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