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ECP External Counterpulsation

"A non-invasive therapy for chronic Angina Pectoris"

Dear Patient: We are writing this page in "non-medical" language to help you understand how the CardiAssist™ External Counterpulsation "ECP" System might help your condition. You should consult with your physician to determine whether you would benefit from ECP?

Just what is angina?
Bypassing the dam!
How can ECP help relieve angina?
How will I feel during and after I finish the therapy?
How long before I feel better?
Are there any negatives to the therapy?
What are my other treatment options?
Does ECP carry any risks?
What advantages does ECP have over other treatments?
Do I need to do anything before having ECP therapy?
Just what is an ECP treatment?
How does ECP treatment help my heart work less?
What does ECP therapy feel like?
How do I know if I qualify for ECP?

Just what is angina?

Angina is a signal from your body telling you that your heart muscle is not receiving enough oxygenated  blood. Over 6 million people in the United States suffer from this condition.

The heart requires an especially enriched supply of oxygen via the incoming blood flow in the coronary arteries. When the vessels that supply the heart with oxygenated blood become narrowed, the area of the heart that is not receiving the proper blood flow responds with a very painful signal called angina pectoris.

Bypassing the dam!

We are all born with some ability to bypass a narrowed vessel by opening tiny branches of other nearby vessels. This process is called "collateral circulation." Think of an irrigation channel and what happens if the channel is blocked. The water naturally finds a new path around the blockage. This is essentially what happens in "collateral circulation." Unfortunately, most of us are not very efficient at developing these new networks of collateral blood flow. This is where ECP comes to the rescue.

Here are pictures of a canine heart before and after the development of "collateral circulation." Note how much more white area (increase circulation) there is after collaterals are developed.

How can ECP help relieve angina?
Your heart is the pump that supplies blood flow throughout the body. It supplies tissues with the oxygen and nutrients that are needed to sustain life. In order to efficiently accomplish this important task, the heart muscle needs oxygen-enriched blood to generate energy for pumping blood to the body. The heart relies on its own set of blood vessels called coronary arteries to receive oxygenated blood.
ECP seems to improve circulation to your heart muscle by opening new pathways that bypass the blocked arteries. Many patients see:

• less medication is required

• fewer angina attacks

• they can do much more physically such as walking, golfing and gardening

• life becomes more "normal"

Ray Richer had bypass surgery in 1980 and an angioplasty in 1990. Despite aggressive medical therapy, even minimal activity would produce shortness of breath and pain in his chest. A t the age of 76, Ray had absolutely no energy. He thought he was coming to the end of his life and would no longer be able to do the things he enjoyed.

Since having CardiAssist™ ECP, Ray has had no angina or shortness of breath. He now walks 11/2 miles, five times a week and mows the lawn. Ray feels great and is very happy with how ECP has helped him. You could say it has given Ray back his life.

How will I feel during and after I finish the therapy?
Most patients describe the treatment as a vigorous massage. They also say that after you get used to it, reading or sleeping during the treatment is very easy. Right after finishing a treatment many are energized or invigorated, but some feel a little tired.

How long before I feel better?
Every patient is different, but most patients start to see improvement about half way through the 7 week cycle. Some feel a positive difference after just a week and some require more than 7 weeks.

Are there any negatives to the therapy?
While most patients only require 35 sessions, some can require more. Also, the 7 week commitment can be a serious consideration for some patients. It is very important that sessions are not missed.

What are my other treatment options?
Some patients may still have the option of bypass surgery, angioplasty, drug therapy or TMR (Transmyocardial Revascularization). You should ask your physician which of the options best matches your situation.

Does ECP carry any risks?
Though rare, some patients can develop minor abrasions from the rubbing of the cuff system. The ECP therapist or your physician can describe any potential risk and/or complications that may occur.

What advantages does ECP have over other treatments?
ECP is less expensive, non-invasive and doesn't require recuperation after treatment. Rather than checking into a hospital, you visit an outpatient facility and can drive yourself home when each session is completed.

Do I need to do anything before having ECP therapy?
Once you know you qualify for ECP therapy there are a few helpful pre-treatment do's, don'ts and facts.

First, you must understand that you are committing to one hour sessions, five days per week, for seven weeks. Interruptions in the daily routine are not good and should be avoided if at all possible. You should plan to spend about an hour and a half each day at your treatment center.

You may feel somewhat tired at the end of the first week, due to the "passive exercise" effect of ECP.

Each day, your therapist will conduct a pre-treatment questionnaire, weigh you and take your blood pressure prior to starting your therapy.

We recommend the following:

• Arrive at least 15 minutes before your scheduled time

• Wear stretch tights to reduce skin irritation

• Wear form fitting underwear, not boxers

• Wear short socks if possible

• Consume very little food or fluids before treatment

• Be sure to urinate before starting the therapy

• Take your med.'s as directed by your physician

• Wear an open necked top, the looser fitting the better

• Bring music (Tape or CD player) or Books on Tape/CD

• Bring your spouse/friend if you like

Just what is an ECP treatment?
ECP is a non-invasive procedure that may reduce the symptoms of chronic angina by stimulating the formation of small branches of blood vessels (collaterals), which create a bypass around the blocked arteries.

Counterpulsation occurs while the heart is resting (diastole). That is when the CardiAssist ™ system actually pumps, sending blood back to the heart. Air is inflated into a series of cuffs (placed on your calves, thighs and buttocks). The system compresses your lower extremities in sequence (like a wave) which increases blood flow back toward your heart. The inflation of these cuffs is timed to your heartbeat so the blood arrives at precisely the time the heart relaxes. A fraction of a second before your heart beats again, the cuffs are instantaneously deflated, enabling the blood in your heart to be pumped (systole), with minimal resistance, into your now empty blood vessels. This of course decreases the amount of work your heart must perform.

It's as simple as 1,2,3...

One: ECP pumps, sending oxygenated blood to the Heart during diastole (the heart is resting)

Two: ECP stops pumping just before the Heart pumps, leaving the blood vessels open, empty and void of resistance

Three: Your angina is reduced, or may even be eliminated

How does ECP treatment help my heart work less?
ECP lowers your pressure during systole (when the heart is pumping) and increases your pressure during diastole (when the heart is resting). As a result your heart doesn't have to work as hard to supply your body with blood flow. The graph below shows clearly how systole decreases and diastole increases. A picture from the CardiAssist™ system follows showing an actual pressure tracing which looks very much like this graph.

What does ECP therapy feel like?
ECP with the CardiAssist™ Counterpulsation System feels like a vigorous massage.

After putting on your stretch tights, 3 electrodes are applied to your chest to provide an ECS signal so that the CardiAssist ™ system will be properly timed to your heart beat. A sensor will also be clipped to your finger to give your blood pressure tracing. This is how your therapist determines the proper settings to maximize the effect of the therapy.

Next, the therapist places the cuff system around your calves, thighs and buttocks. When activated, the cuffs provide what Dr. Kenneth Sunnnergren, Lewes, Delaware calls "leg-hugs". These leg-hugs™ start in a wave form up the legs from the calves, to the thighs and finally the buttocks.

This is an example of what your ECG (top tracing) and blood pressure PPG (bottom tracing) may look like while receiving ECP therapy.

How do I know if I qualify for ECP?
Only your doctor can evaluate your condition and determine if you are a candidate for ECP, but the general criteria are:

• You have angina symptoms

• You have had previous invasive procedures, but the pain remains or has returned

• Nitroglycerin no longer gives you relief

• Your physician has determined that you are no longer a candidate for any invasive procedure

There are some conditions your physician can communicate to you that would prohibit you from receiving ECP treatment.

Lynn Butler, 51, had Coronary Artery Bypass Surgery 8 years ago. However, like many diabetics, his grafts closed back up again. Since he was not a candidate for additional surgery or angioplasty, Mr. Butler was told by his Cardiologist to go home and take it easy. Adding to Mr. Butler's burden was the psychological impact of his Cardiologist's statement that there was nothing else that could be done. His only option, or so he thought, was to sit at home, take his medicine and pray he would make it through another day.

Although skeptical at first, after receiving 35 CardiAssist ™ ECP treatments, Lynn is now living life again. It has been months since he last took any nitroglycerin and he now works a 40 hour work week. Lynn is now a firm believer saying, " I have my life back without drugs, surgery or angioplasty, amazing."

Al Bisignano smoked 3+ packs of cigarettes a day for 30 years. He had to have quintuple bypass in 1985 and has a history of chronic obstructive pulmonary disease. Over the past few years he found it more difficult to breathe and had no energy for doing everyday things. He became very cautious about participating in any activity because it would produce angina. Even walking very short distances would give him angina and shortness of breath.

Since completing his ECP treatment 10 months ago, 73 year old Al says he is now walking every day with no pain or shortness of breath. He also notes that he had a new prescription filled for nitroglycerine prior to starting Card/Assist™ ECP therapy 10 months ago, but has not yet had the need to take even one pill from the bottle. Al is feeling great, is more energetic, is doing handyman chores around the house and even better, is enjoying dancing and being able to live a normal life again.

John Bartolomeo is a 55 year old teacher who had a MI in April, 1999. CPR was initiated and he was shocked more than 10 times. The doctors in the hospital were pessimistic about his recovery and stated that the chances for John's returning to a normal life were minimal. John did recover however, and because he did not want any interventional procedures, he signed himself out of the hospital against the doctor's orders and into the care of his own cardiologist, who recommended External Counter-pulsation.

John is now back teaching full time and feels he has a new "lease on life", thanks to CardiAssist ™ ECP.

Though only 50 years of age, Akshay Patel suffered with chest pain, shortness of breath, fatigue and the frequent need for nitroglycerine. His ability to work was very limited due to the onset of one or all of these symptoms. He had 4 arteries that were blocked, and it was recommended that he have at least an angioplasty for symptomatic relief. However, Akshay did not want to have any invasive procedures until he had exhausted all other options, one of which turned out to be ECP.

It has now been over I year since he finished his ECP course of treatment and he is still delighted with the fact that he can now climb stairs (even up to 7 floors) with no shortness of breath or chest pain. He no longer needs to take one of his medications and the others have been cut in half by his physician. His use of nitroglycerine has dropped dramatically...he has not had to take ANY since having Card! Assist ™ ECP therapy! Akshay is very happy with the fact that having the ECP treatment has eliminated the need to have any invasive procedures.

For more information on the ECP program, call 727/329-1626.