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Some people may not be candidates for EECP treatment because of their medical conditions. Only a physician can make a decision regarding whether or not you are a candidate for EECP treatment.
Once you are eligible to receive EECP treatment, it is important that you understand the treatment schedule. Patients typically attend one-hour treatment sessions once a day, five days a week for seven weeks. Many people receive treatment, without interruption to their employment, by scheduling their sessions before or after work
To make sure the treatment goes smoothly, please follow your Pre-Treatment Instructions, which will be similar to those at the back of this booklet. You may wish to bring a book, a magazine, or a portable CD or tape player with earphones. You also may wish to invite a family member or friend to accompany you.
At the EECP center, your therapist will explain each step as you go through treatment. You may be given a pair of stretch pants to wear at each treatment session. Although treatment usually takes one hour, you should plan to spend approximately 1-1/2 hours at the treatment center.
Once patients have changed clothes, a therapist will weigh them, and take their blood pressure. Patients will lie on a padded table in a treatment room. Three electrodes will be applied to the patient’s chest to take a constant ECG reading during treatment. A finger sensor, called a plethysmograph, will be placed over patient’s finger like a thimble. This sensor records tracings that represent blood pressure.
The therapist will wrap a set of inflatable cuffs around patient’s calves, thighs, and buttocks. Patients are likely to feel a sensation of a strong “hug” moving upwards from the calves to thighs to buttocks during inflation followed by the rapid release of pressure on deflation.
Clinical Pathway to Symptomatic Coronary Artery Disease and Ischemic Heart Disease
Patients Who May Benefit from EECP Therapy
Patients with angina or angina equivalent symptoms who:
- No longer respond to optimum medical therapy
- Restrict activities to avoid symptoms
- Are unwilling to undergo additional invasive revascularization procedures
- Have LV dysfunction (EF<40%), ischemic cardiomyopathy
- Have co-morbid conditions that increase the risk of revascularization procedures
- diabetes
- heart failure
- pulmonary disease
- renal dysfunction
- Have LV dysfunction (EF<40%), ischemic cardiomyopathy
- Have LV dysfunction (EF<40%), ischemic cardiomyopathy
Heart failure patients in a euvolemic state with:
- Ischemic heart failure (e.g. CAD, prior MI)
- Co-morbid conditions that increase the risk of complications of revascularization procedures
Diabetic patients known to be at greater risk for post-procedural complications
Elderly patients at high risk for morbidity/mortality from PCI/CABG
Indications
- Stable or unstable angina
- Congestive heart failure
- Acute myocardial infarction
- Cardiogenic shock
Contraindications
- Arrhythmias that interfere with machine triggering
- Bleeding diathesis
- Active thrombophlebitis
- Severe lower extremity vaso-occlusive disease
- Presence of a documented aortic aneurysm requiring surgical repair
- Pregnancy
Precautions
- Patients with blood pressure higher than 180/110 mmHg should be controlled prior to treatment with enhanced external counterpulsation.
- Patients with a heart rate of more than 120 bpm should be controlled prior to treatment with enhanced external counterpulsation.
- Patients at high risk of complications from increased venous return should be carefully chosen and monitored during treatment with enhanced external counterpulsation. Decreasing cardiac afterload by optimizing diastolic augmentation may help minimize increased cardiac filling pressures due to increased venous return.
- Patients with clinically significant valvular disease should be carefully chosen and monitored during treatment with enhanced external counterpulsation. Certain valve conditions, such as significant aortic insufficiency or severe mitral or aortic stenosis, may prevent the patient from obtaining benefit from diastolic augmentation and reduced cardiac afterload in the presence of increased venous return