About seven years ago, after experiencing multiple bouts of breathlessness, fatigue and discomfort in the limbs during physical activities such as walking and climbing stairs, Pune-based entrepreneur Deepak Landge underwent a detailed cardiac health examination.
The tests showed that his heart’s pumping rate (ejection fraction) was below 20%. (A healthy heart should have a rate between 50% and 70%.) Landge was at serious risk of suffering heart failure and needed immediate intervention.
That was when a non-invasive procedure came to his rescue.
“I was deeply confused, and I happened to spot a newspaper advertisement about enhanced external counterpulsation (EECP) being offered at a preventive cardiology centre in Pune,” he says.
After gathering more information about EECP, Landge chose to opt for the treatment. Today, after completing 35 sessions (full course) of the therapy, he is much better and his ejection fraction rate has risen to 35%.
“I feel healthy as a normal person and can climb stairs and indulge in physical activities with ease,” says Landge, who is 68. “I also regularly play table tennis with youngsters in my residential society.”
What is EECP?
During EECP, three pairs of cuffs (like BP monitor cuffs) — strapped on the legs, thighs and buttocks — are continuously inflated and deflated in a synchronised manner from the leg upwards, while the heart is connected to an ECG monitor.
The aim is to squeeze blood from the leg vessels into the aorta (main artery) to increase pressure between each heartbeat (relaxation period) so that more blood is pushed through the arteries towards the heart.
The whole therapy can be finished in three to 12 weeks depending upon the number of sessions taken in a week.
Why is EECP called a natural bypass?
“EECP therapy works on naturally occurring collaterals and branches so that blood from the open arteries reaches areas not getting the blood due to blocked arteries,” says Dr Sanjay Mittal, senior director, clinical cardiology and research, Medanta-The Medicity, Gurugram, Haryana. “Therefore, it’s called a natural bypass.”
Collaterals are alternate blood vessels that branch out from the aorta into tinier capillary vessels for blood circulation.
Not for everyone: cardiac conditions apply
Dr Mittal says that angioplasty, bypass surgery and EECP therapy are not permanent solutions for better blood circulation and have to be supplemented with an active lifestyle and healthy diet.
EECP is usually done on people with chronic artery complications that tend to progress slowly. It is not recommended for people with acute artery complications — who might require immediate medical attention, like someone with an unstable angina (chest pain), which could even cause a heart attack.
Dr Mittal says EECP could be used in cases of chronic heart failure, chronic stable angina syndrome and diffuse coronary heart disease.
But Dr Keshava R, director, interventional cardiology, Fortis Hospital, Bengaluru, says EECP is not a first line of treatment. “It is the fourth or fifth line of treatment,” he says.
Dr Keshava adds that EECP therapy can be performed on those people with persistent angina (chest pain) who are unsuitable for angioplasty or surgery (because of comorbidities like age, and serious problems with lungs and kidneys) and are on maximum medication. He emphasises that it is a temporary treatment and that angina can reappear.
Dr Sanjay Bhat, senior consultant, interventional cardiology, Aster CMI Hospital, Bengaluru, agrees. “[EECP] is given to individuals with a chronic ischemic disease where revascularisation therapy is not possible,” he says. “It is neither beneficial nor harmful.”
EECP should be done under proper supervision
“Sometimes EECP is also used on people diagnosed with a weak heart,” says Dr Mittal. He adds that acute heart failure is characterised by breathlessness and swelling in the legs due to water retention. It is important to stabilise the patient by decongesting the fluid. Proper medication must be taken to control the heart overload before proceeding with counterpulsation.
“EECP would be a wonderful treatment choice if the person has a weak heart and the arteries of the heart cannot be bypassed,” says Dr Mittal. “I have been using EECP in these situations time and again, with excellent results.”