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Enhanced External Counterpulsation (EECP)
Basic Facts
Enhanced external counterpulsation (EECP) is a noninvasive, outpatient treatment for chronic stable angina (chest pain).
EECP is recommended for patients who may have exhausted other treatment methods, such as bypass surgery, angioplasty, or antianginal medications.
EECP may provide benefits long after the treatment is completed, and some patients remain symptom free for years.
Enhanced external counterpulsation (EECP) is a noninvasive, outpatient treatment for chronic stable angina. EECP uses cuff-like devices on the legs that increase blood flow to the heart by squeezing in sequence with the heartbeat. It may help the blood flow past blocked or partially blocked arteries by rerouting the blood through nearby artery branches (called collateral circulation).


Patients should wear tights or leggings and urinate before the session.


Typically, physicians consider people with the following conditions to be eligible for EECP:
  • Chronic stable angina that has not been helped by medication;
  • Diseases or conditions that would make them poor candidates for surgery; or
  • Heart problems that persist despite previous bypass surgeries or angioplasty procedures.
EECP is not recommended for patients with:
  • Uncontrolled heart failure;
  • Blood pressure higher than 180/110 millimeters of mercury (mmHg);
  • A heart rate higher than 120 beats per minute;
  • Very irregular heart rhythm;
  • Lung disease;
  • A history of phlebitis (vein inflammation); and
  • Aortic insufficiency, which results from weakening of the aortic valve.
Pregnant women should not undergo EECP.


EECP is conducted in a series of 35 one-hour sessions.

The patient lies on a bed. ECG electrodes are fixed to the patient's chest and a plethysmograph is attached to the patient's finger. EECP cuffs are wrapped around the patient's calves, lower thighs, and upper thighs. The cuffs are inflated and deflated from calves to upper thigh according to the rhythm of the patient's heartbeat. Just before the heart pumps, all of the cuffs deflate simultaneously.


EECP requires no recovery period.


Complications from EECP can include:
  • Mild headache;
  • Mild dizziness;
  • Fatigue;
  • Muscle aches; and
  • Pressure sores, skin irritation, or bruising.
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