eecp: the natural bypass (enhanced external counterpulsation) · •vegf- increases 21% with 1 hour...
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EECP: The Natural Bypass (Enhanced External Counterpulsation)
Objectives
o Identify patient populations who should & should not have EECP.
o Summarize mechanism by which EECP tx is provided.
o Cite changes that occur to blood flow and blood vessels as a result of EECP tx.
o List EECP’s wide ranging benefits.
What is EECP?
• Treatment clinically proven to improve blood circulation and strengthen the CV system
• BP cuffs
• Promotes development of new blood vessels
• Reduction of s/s
Origin of EECP
o hydraulic device, water
o 1970’s
• Studies
• Focus on high tech, invasive approaches
o Renewed interest early ‘90’s
• FDA approved 1995
• Medicare 1999
Early external
counterpulsation
devices had
hydraulic pulsator
chambers.
Why Do We Need EECP?
o 10 million patients chronic angina
o 1/4-1/3 refractory angina
Who Should Have EECP?
o Coronary artery disease and angina
• CCS III and IV
Who Should Not Have EECP?
o Severe aortic insufficiency
o AAA >5 cm
o Hemophilia
o Uncontrolled hypertension >180/110 mmHg
o Pregnant, fever, open wound, current blood clot
https://www.youtube.com/watch?v=vjU29pxyTlM
Qualities of EECP Therapist
o Clinical assessment
o Wrap cuffs tightly
o Full Pressure (280 mmHg)
o Timing
o Coach
Safe
o NO risk of stroke, infection, cognitive impairment, bleeding.
No Recovery Time
o No convalescence- before work, lunch break.
Noninvasive
o No drugs, needles, IV, tubes, knives.
Painless
o Sleep, t.v. , music, chat
o “Bouncing appearance”
Saves $$
o Up front cost: $6000 full course EECP-
1/3 cost PCI, 1/6 cost CABG.
o Long term savings
o $215.6 billion lost annually
Good for the Soul
• Quality of life, emotional improvements
What Does EECP Do To Blood Flow?
o Diastolic augmentation- (sequential)
• Enhances venous blood flow
• Retrograde flow coronary circulation =
myocardial perfusion
o Systolic “unloading”- (simultaneous)
• Decreases heart’s demand for blood and oxygen
• Beat with increased force
Principles of Operation
Systolic Deflation Simultaneously deflate all three
sets of cuffs at the end of diastole
Effect:
Systolic Unloading
Reduce Cardiac
Workload
Increase
Cardiac
Output
Lower
Thigh
Cuffs
Upper
Thigh Cuffs
Calf Cuffs
Diastolic
Augmentation
Increase
Coronary Perfusion
Increase
Cardiac Output
Sequential inflate three
sets of cuffs at the end of
systole
Diastolic Inflation
ECG
Normal
EECP
Effects:
Increase
Venous Return
Lower
Thigh Cuffs
Upper Thigh
Cuffs
Calf Cuffs
Blood Vessels
o Organs- alive, dynamic, growing
o Exercise blood vessels- adequate blood transport
What Happens To Blood Vessels During EECP?
o Enhances vascular reactivity o Shear stress= anti-inflammatory properties o Endothelin (ET-1)- constricts, retains water & salt
• Decreases 40% during • 20% at one month post
o Nitric oxide- dilates and strengthens • Increases 60% during • 20% at one month post
o Endothelium release natural chemicals angiogenic growth factors • VEGF- increases 21% with 1 hour EECP
Natural Bypass
o Collaterals- “potential” blood vessels
o “wake up” or “recruite”
o Enlarge, strengthen, new lasting pathways
Heart Untreated Heart Treated with EECP
Benefits Of EECP!
o Increased: • Activity level • Blood flow • Quality of life • Energy • Cardiac output
o Decreased: • Anginal episodes 72-85% • Hospitalizations, ED visits 85% (in year following tx) • Nitroglycerin use 81% • Functional classification (CCS) by 1 class • Depression, anxiety
“Off Label” Uses of EECP
o PVD o Sleep o Erectile dysfunction o Athletes o Ocular o Renal o RLS o Tinnitus o Stroke o Alzheimer’s o Parkinson’s
Case Study
o 65 year old
o MI & CABG 1996
o Ischemic cardiomyopathy, EF= 25-30%
o ICD 2011
o TIA post PCI 2014
o Chronic angina
Jack
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