• Enhanced External Counterpulsation



    Enhanced external counterpulsation (EECP) is a treatment for chronic, stable chest pain ( angina ). Angina happens when there is not enough blood and oxygen being pumped to the heart to support the work it is doing.
    Cuffs (similar to blood pressure cuffs) are placed on the legs. These cuffs inflate (fill with air) and deflate in rhythm with the heart to push blood back toward the heart. EECP increases the amount of blood reaching the heart so the heart does not have to work so hard. This helps improve circulation.
    The Cardiovascular System
    EECP pushes blood back toward the heart to reduce the heart's workload.
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    You may have EECP to treat angina if:
    • Your medicines are not working well enough
    • You are not a good candidate for surgery
    • Your doctor wants you to try nonmedical alternative before considering surgery
    • You have had surgery but are still having chest pain
    You may have EECP to treat heart failure if:
    • Your heart function, known as ejection fraction (EF), is less than 35% and you are not having active symptoms of shortness of breath—Talk to your doctor about your EF.
    • You are still having symptoms after being given all appropriate medicines for your heart
    The benefits of EECP may include:
    • Decreased need for angina medicines
    • Decrease in symptoms of angina
    • Ability to do activities (eg, exercise) without angina
    • Improved heart function if a lack of oxygenated blood flow is a problem

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have EECP, your doctor will review a list of possible complications.
    The most common complication is skin irritation due to the inflatable cuffs. You may have:
    • Chafing
    • Bruising or blisters
    • Bleeding if your blood is too thin
    • Leg or waist pain
    • Worsening of heart failure in people who have certain heart rhythm abnormalities
    You should not have EECP if you are pregnant or have any of these conditions:

    What to Expect

    Prior to Procedure

    Before you begin EECP, your doctor may:
    • Discuss your medical history
    • Discuss any medicines you are taking—Your doctor may not recommend EECP if you take blood thinners, like heparin or warfarin .
    • Answer any questions you have about the procedure
    You may want to wear tight-fitting, seamless pants. This can help prevent chafing from the cuffs.


    You will not be given any anesthesia. EECP is not painful.

    Description of Procedure

    You will lie on a padded table. Electrodes will be placed on your chest to monitor your heart rhythm. Your blood pressure will also be monitored.
    Cuffs will be placed on your calves and upper and lower thighs. The cuffs attach to air hoses that will inflate and deflate them in rhythm with your heart. You will feel a strong “hug” from the cuffs, beginning at your calves and moving to your upper thighs. The cuffs will inflate 60-80 times each minute during the treatment.

    How Long Will It Take?

    You will be treated for a total of 35 hours. Treatments are usually given 1-2 hours per day over seven weeks.

    How Much Will It Hurt?

    EECP is not painful. You may feel uncomfortable when the cuffs tighten on your legs.

    Post-procedure Care

    After your treatment, the electrodes and cuffs will be removed. You can go home as soon as you are done with treatment. You may feel slightly tired after the treatment. This feeling will get better over time.
    When you return home, do the following to help manage your angina:

    Call Your Doctor

    After arriving home, contact your doctor or call for medical help right away if there are signs that your angina is getting worse:
    • Severe chest pain (feels tight or heavy)
    • Shortness of breath
    • Numbness or tingling in shoulder, arm, or wrist
    • Nausea
    • Symptoms not relieved with medicine
    In case of an emergency, call for medical help right away.


    American Heart Association http://www.heart.org/

    National Heart Lung and Blood Institute http://www.nhlbi.nih.gov/


    Canadian Cardiovascular Society http://www.ccs.ca/

    Heart and Stroke Foundation of Canada http://www.heartandstroke.com/


    Amin F, Al Hajeri A, Civelek B, et al. Enhanced external counterpulsation for chronic angina pectoris. Cochrane Database of Systematic Reviews . 2010;2:CD007219.

    EECP: what is enhanced external counterpulsation (EECP)? HeartHealthyWomen.org website. Available at: http://www.hearthealthywomen.org/treatment-and-recovery/enchanced-external-counterpulsation-eecp/eecp.html . Accessed July 13, 2011.

    Enhanced external counterpulsation. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/heart/disorders/cad/eecp.aspx . Accessed July 13, 2011.

    Enhanced external counterpulsation (EECP). The Ohio State University Medical Center Heart and Vascular center website. Available at: http://medicalcenter.osu.edu/heart/conditions/pages/treatments/eecp.aspx . Accessed July 13, 2011.

    How is angina treated? National Heart Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina%5FTreatments.html . Accessed July 13, 2011.

    What is angina? American Heart and Stroke Association website. Available at: http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm%5F300287.pdf . Accessed July 13, 2011.

    Manchanda A, Soran O. Enhanced external counterpulsation and future directions: step beyond medical management for patients with angina and heart failure. J Am Coll Cardiol . 2007;50(16):1523-1531.

    Revision Information

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