Dr. Debra Braverman offers answers to some of the most commonly asked
questions about EECP. If you do not see your questions or concerns
addressed here, please email Dr. Braverman at: firstname.lastname@example.org. She will respond to you directly as quickly as possible.
Q: What is angina?
Angina is the global term for all symptoms associated with coronary
artery disease, which occurs when the heart is not receiving enough
blood. It occurs when vessels that carry blood to the heart muscle
become dysfunctional, and are often narrowed or blocked. Angina may
feel like chest pain or pressure, shortness of breath, pain in the jaw,
neck, arms, back, nausea, or generalized fatigue. Each patient
experiences angina differently.
Q: What does EECP stand for?
A: The acronym EECP stands for Enhanced External Counterpulsation.
Q: What is EECP?
EECP is a non-invasive, outpatient treatment for heart disease that is
used to relieve or eliminate angina. During the treatment, blood
pressure cuffs are wrapped around your legs, and squeeze and release in
sync with your heartbeat, promoting blood flow throughout your body and
particularly to your heart. In the process, EECP develops new pathways
around blocked arteries in the heart by expanding networks of tiny
blood vessels (“collaterals”) that help increase and
normalize blood flow to the heart muscle. For this reason, it is often
called the natural bypass.
Q: What are the advantages of EECP?
Unlike bypass surgery, balloon angioplasty, and stenting procedures,
EECP is non-invasive, carries no risk, is comfortable, and is
administered in outpatient sessions.
Q: Are there any risks or side effects of EECP?
EECP is safe. Occasionally, some patients experience mild skin
irritation under the areas of the blood pressure cuffs. Experienced
EECP therapists address this irritation by using extra padding where
needed to make the patient comfortable. Some patients experience a bit
more fatigue at the beginning of their course of treatment, but it
usually subsides after the first few sessions. In fact, patients
typically feel energized by EECP.
Q: How long does EECP take?
The standard course of treatment is one hour per day, five days per
week, for seven weeks (a total of 35 one-hour sessions). Some patients
have two treatments in one day in order to complete the program more
quickly. Some patients extend the program beyond 35 treatments,
depending on their particular medical situation and goals.
Q: When can I expect to start feeling better from EECP?
Most patients begin to experience beneficial results from EECP between
their 15th and 25th treatments. These benefits include increased
stamina, improved sleeping patterns, decreased angina, and less
reliance on nitroglycerin and other medications. There is variation,
certainly, and some patients start to feel better as soon as their
first week of treatment!
Q: What happens if I miss a treatment?
You are encouraged to come for your EECP treatment everyday. However,
missing a day will not have a negative effect on your overall results.
When you come back, you will simply pick up where you left off, and the
missed treatment will be added to the end of your program until you
have a total of 35 sessions. Just like exercise, the more consistent
you are with your EECP schedule, the better your results will be.
Q: What does EECP feel like?
EECP feels like a deep muscle massage to your legs. During the
treatment, you do not feel anything in the chest or heart. You only
feel the cuffs that are wrapped around your legs squeezing in time to
your own heartbeat. Our patients have affectionately described this
sensation as “gentle hugs.” Most of our patients relax,
listen to music, or read during their treatments. Some even sleep!
Q: Do the benefits of EECP last?
Yes. In patients followed for three to five years after treatment, the
benefits of EECP, including less angina, less nitroglycerin usage, and
improved blood flow patterns documented on stress tests, had lasted.
Q: How does EECP compare to angioplasty or bypass surgery?
A: The five-year outcomes for EECP patients are virtually the same as for angioplasty and bypass surgery patients.
Q: Is EECP FDA-approved? What kind of research has been done on it?
EECP was approved by the FDA in 1995 as a treatment for coronary artery
disease and angina, cardiogenic shock, and for use during a heart
attack. In 2002, the FDA approved EECP as a treatment for congestive
heart failure. It has undergone rigorous clinical trials at leading
universities around the country and EECP has been the subject of more
than 100 scientific studies published in leading medical journals
throughout the world. (Please see our Clinical Studies page for more information.)
Q: Does insurance pay for EECP?
A: Yes. EECP is covered by Medicare and paid for by private insurance carriers.
Q: I have a pacemaker.
Is that a problem with EECP?
A: No. Pacemakers and internal defibrillators do not interfere in any way with EECP.
Q: I am on Coumadin. Is that a problem with EECP?
A: No. Patients on Coumadin are able to undergo EECP treatments safely.
Q: I have congestive heart failure (CHF). Is that a problem with EECP?
No. In fact, in July 2002 the FDA approved EECP as a treatment for
congestive heart failure (CHF). After completing a course of EECP
treatment, patients with CHF typically have less swelling in their
legs, less shortness of breath, less fatigue, and often require less
Q: Is there an age limit for EECP?
No. We have successfully treated patients as young as 36 and as old as
97 without any difficulties. Many of our patients are in their 80s and
90s and complete the entire EECP program with excellent results.
Q: I have already had bypass surgery/angioplasty/stents. Can I still have EECP?
Yes! Most of our patients have already had one (or many) of these
procedures. They come for EECP treatment because they still have angina.
Q: Can EECP dislodge plaque and cause a stroke or heart attack?
No. Our bodies obey the laws of physics, and one principle law is that
fluid will follow the path of least resistance. Atherosclerotic plaques
are calcified and hard, and they create an obstruction that detours the
blood through alternate routes. During EECP, when your blood is flowing
to your heart, it will naturally bypass arteries with plaque and enter
healthy, non-diseased blood vessels to go around the blockages. Going
around the blockages is a longer trip, but it is a much easier one. In
time, these new pathways are reinforced and become lasting routes for
blood to reach your heart beyond the blockages. Every EECP patient has
had multiple, serious blockages. No one has ever had a heart attack or
a stroke as a result of the treatment.
Q: Are there any patients who are not able to have EECP?
There are very few patients who are unable to have EECP. Those who
should not be treated include pregnant women, individuals with a severe
leakage in their aortic valve requiring surgical repair, and patients
with an active blood clot in their leg.
Q: I had a blood clot in my leg three years ago. Can I have EECP?034958
Yes. Having a history of a blood clot (deep venous thrombosis or DVT)
in your leg does not preclude you from having EECP. It is recommended
that you have a Doppler ultrasound of your leg to confirm the blood
clot has resolved before beginning the EECP program.
Q: Does EECP aggravate high blood pressure (hypertension)?
No. If you have hypertension that is properly managed, you may undergo
EECP without difficulty. Oftentimes, patients with hypertension find
that their blood pressure improves as they proceed with EECP. If your
hypertension is uncontrolled, you must seek medical care to get your
blood pressure under control with proper medications before proceeding
Q: I have bad circulation in my legs (peripheral vascular disease or PVD). May I still have EECP?
Yes, and you should! EECP improves blood flow throughout the entire
body, including your legs. If you have poor leg circulation, you might
need more than 35 treatments. My patients typically require at least 50
treatments to get the full benefit of the program. In addition to
improved stamina, less angina, and less nitroglycerin use, patients
with PVD have a marked improvement in their leg circulation in response
Q: I have atrial fibrillation and an irregular heartbeat. May I still have EECP?
Yes. An irregular heartbeat, including one caused by atrial
fibrillation, will not interfere with EECP if the heart rate is
controlled and no faster than 100 beats per minute.
Q: I have varicose veins. May I still have EECP?
Yes. Varicose veins are typically a cosmetic issue, not a medical one.
As such, they do not preclude individuals from receiving EECP. We often
use extra padding in patients with varicose veins to ensure maximum
Q: What happens if my angina returns months or years after I finish my EECP treatment course? Can I come back for more?
Yes. EECP is not a once-in-a-lifetime treatment. Heart disease is a
chronic illness and symptoms may return at some point in the future.
The door is always open for you to return for additional courses of
EECP as needed.
Q: Is EECP similar to chelation therapy?
No. There is no relationship between EECP and chelation therapy.
Chelation is an invasive procedure whereby a substance called EDTA is
given intravenously in an attempt to bind to calcium and remove it from
atherosclerotic plaques. The fundamental problem with the concept of
chelation is that atherosclerotic plaques are not only made of calcium;
they include fat, cholesterol and cellular deposits as well. Chelation
is a technique which has never been shown by scientific research to
have any therapeutic value for heart disease. Since it has never been
proven to work, chelation is not paid for by Medicare or any insurance
carrier, and therefore is not accessible to most heart disease
patients. Patients who choose to try it must pay out of pocket. Each
treatment costs approximately $80-$100, and patients often go for
numerous treatments over a period of several months, and then continue
indefinitely on a maintenance regimen. Chelation can actually be
harmful – even fatal – when administered to the wrong
person or under the wrong circumstances. It poses particular danger to
individuals with congestive heart failure. The amount of fluid
administered with each treatment may overtax their weakened heart,
leading to severe fluid overload and problems including pulmonary edema
(a life-threatening condition in which there is an excess of fluid in
In contrast, EECP is entirely non-invasive, proven by hundreds of
published scientific studies, and safe. It is an accepted, mainstream
medical treatment and, as such, is approved by Medicare and covered by
insurance. Chelation does not interfere with EECP, so you may undergo
both simultaneously if you choose.
Q: Is there a difference between EECP and ECP?
Yes. EECP and ECP are very different things. EECP is a registered
trademark of Vasomedical, Inc., the leading manufacturer of EECP
equipment in the U.S. Vasomedical has a patent on the timing mechanism
of the machine (when the cuffs squeeze and release in time to the
patient’s EKG, the most critical part of the treatment). This
timing mechanism distinguishes them from their competitors who make
other external counterpulsation (ECP) equipment, and makes the EECP
machine by far the most clinically effective device on the market.
Every published U.S. study (more than 100 of them) and most studies
originating in countries around the world and published in the leading
English-language medical journals have used the Vasomedical EECP
equipment exclusively. Accordingly, EECP – not ECP –
machines are the ones found in every university hospital, major
community hospital, and well-known practice that offers the treatment.
Have a question that wasn't
addressed here? You can
submit your question or comments through our Contact
Us page, and Dr. Braverman will respond to you directly. Or, you may call us at 215-342-2100.