5/18/2017 External counterpulsation - Wikipedia

External counterpulsation
From Wikipedia, the free encyclopedia

External counterpulsation therapy (ECP) is a procedure performed on

individuals with angina or heart failure or cardiomyopathy in order to
diminish symptoms of ischemia, improve functional capacity and quality of
life. In various studies, ECP has been shown to relieve angina,[1][2] and
decrease the degree of ischemia in a cardiac stress test.[2][3]

Contents
1 Method
2 Physiological considerations
3 Indications and Contraindications Illustration depicting Cardiac
3.1 Indications External Counterpulsation
3.2 Contraindications
4 See also
5 References

Method
While an individual is undergoing ECP, he/she has pneumatic cuffs on his or her legs and is connected to telemetry
monitors that monitor heart rate and rhythm. The most common type in use involves three cuffs placed on each leg
(on the calves, the lower thighs, and the upper thighs (or buttock)). The cuffs are timed to inflate and deflate based on
the individual's electrocardiogram. The cuffs should ideally inflate at the beginning of diastole and deflate at the
beginning of systole. During the inflation portion of the cycle, the calf cuffs inflate first, then the lower thigh cuffs
and finally the upper thigh cuffs. Inflation is controlled by a pressure monitor, and the cuffs are inflated to about 200
mmHg.

When timed correctly, this will decrease the afterload that the heart has to pump against, and increase the preload that
fills the heart, increasing the cardiac output.[4] In this way, ECP is similar to the intra-aortic balloon pump (IABP).
Since it increases pressure in the aorta while the heart is relaxing (during diastole) ECP also increases blood flow into
the coronary arteries, which also occurs during that phase.

Physiological considerations
One theory is that ECP exposes the coronary circulation to increased shear stress, and that this results in the
production of a cascade of growth factors that result in angiogenesis.[5] ECP is a rehabilitation process that provides
mechanical external cardiac assistance on a consistent regimen resulting in significant improvement in energy and
exercise tolerance much like an exercise program. By restoring oxygenated blood flow, there are abundant benefits to
the body. This restoration of nutrient rich blood flow revives tissue in parts of the heart and body that have become
'stunned' or 'hibernated' due to restricted or blocked blood flow. The heart benefits greatly as patients will see an
improvement in structure, strength (contracility) and a reduction in afterload (workload) due to the reduction in
systemic vascular resistance. Patients will see improvements in symptoms of chest pain, shortness of breath, chronic
fatigue (tiredness) as well as a significant improvement in exercise tolerance (energy).
https://en.wikipedia.org/wiki/External_counterpulsation 1/3
5/18/2017 External counterpulsation - Wikipedia

Indications and Contraindications

Indications

Angina patients who are not relieved by medicine

Patients who dont want to have bypass surgery
Patients who are contraindicated for bypass or angioplasty due to kidney failure, liver failure, severe COPD
cases, diffuse diabetes disease, very old age, patients of Syndrome X, ischaemic and dilated cardiomyopathy

Contraindications

Severe aortic regurgitation or aortic stenosis

Deep vein thrombosis
Pregnancy
Very high blood pressure
Severe peripheral vascular disease
Possibility of stroke

See also
Cardiomyopathy
Ischemic cardiomyopathy
Coronary circulation
Intra-aortic balloon pump

References
1. Zheng ZS, Li TM, Kambic H, et al. (1983). "Sequential external counterpulsation (SECP) in China". Trans Am Soc Artif
Intern Organs. 29: 599603. PMID 6673295 (https://www.ncbi.nlm.nih.gov/pubmed/6673295).
2. Arora RR, Chou TM, Jain D, et al. (June 1999). "The multicenter study of enhanced external counterpulsation (MUST-
EECP): effect of ECP on exercise-induced myocardial ischemia and anginal episodes" (http://linkinghub.elsevier.com/retri
eve/pii/S0735-1097(99)00140-0). J. Am. Coll. Cardiol. 33 (7): 183340. doi:10.1016/S0735-1097(99)00140-0 (https://do
i.org/10.1016%2FS0735-1097%2899%2900140-0). PMID 10362181 (https://www.ncbi.nlm.nih.gov/pubmed/10362181).
3. Lawson WE, Hui JC, Zheng ZS, et al. (1996). "Improved exercise tolerance following enhanced external counterpulsation:
cardiac or peripheral effect?". Cardiology. 87 (4): 2715. doi:10.1159/000177103
(https://doi.org/10.1159%2F000177103). PMID 8793157 (https://www.ncbi.nlm.nih.gov/pubmed/8793157).
4. Werner D, Schneider M, Weise M, Nonnast-Daniel B, Daniel WG (October 1999). "Pneumatic external counterpulsation: a
new noninvasive method to improve organ perfusion" (http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(99)00477-
4). Am. J. Cardiol. 84 (8): 9502, A78. doi:10.1016/S0002-9149(99)00477-4 (https://doi.org/10.1016%2FS0002-9149%
2899%2900477-4). PMID 10532522 (https://www.ncbi.nlm.nih.gov/pubmed/10532522).
5. Soran O, Crawford LE, Schneider VM, Feldman AM (March 1999). "Enhanced external counterpulsation in the
management of patients with cardiovascular disease". Clin Cardiol. 22 (3): 1738. doi:10.1002/clc.4960220304 (https://do
i.org/10.1002%2Fclc.4960220304). PMID 10084058 (https://www.ncbi.nlm.nih.gov/pubmed/10084058).
Manchanda A, Soran O (October 2007). "Enhanced external counterpulsation and future directions: step beyond medical
management for patients with angina and heart failure" (http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)02392-
3). J. Am. Coll. Cardiol. 50 (16): 152331. doi:10.1016/j.jacc.2007.07.024 (https://doi.org/10.1016%2Fj.jacc.2007.07.02
4). PMID 17936150 (https://www.ncbi.nlm.nih.gov/pubmed/17936150).

Retrieved from "https://en.wikipedia.org/w/index.php?title=External_counterpulsation&oldid=725538457"

https://en.wikipedia.org/wiki/External_counterpulsation 2/3
5/18/2017 External counterpulsation - Wikipedia

Categories: Cardiac procedures

This page was last edited on 16 June 2016, at 08:34.

Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. By
using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia is a registered trademark of the
Wikimedia Foundation, Inc., a non-profit organization.

https://en.wikipedia.org/wiki/External_counterpulsation 3/3