Information on External Counterpulsation ECP

Exercise is good for your health it burns calories, which can help you maintain or reach a healthy weight. Regular exercise improves factors linked to cardiovascular health, resulting in lower blood pressure, healthier cholesterol levels, and better blood sugar regulation. Exercise also promotes positive physiological changes, such as encouraging the heart's arteries to dilate more readily. It also helps your sympathetic nervous system (which controls your heart rate and blood pressure) to be less reactive. Running is an exercise that promotes physical health by enhancing cardiovascular endurance, strengthening muscles and building strong bones as it is a weight-bearing exercise, but also has an implication in lowering mental health burdens. But these changes may take weeks, months, or even years to reach their full effect.

When you start out on a run or a walk but feel tired or have angina fairly quickly, so you walk for a few minutes slowly. But once you start running again, it feels remarkably easier on the second try this is known as "warm-up angina" this phenomenon was first described some 200 years ago.

A single exercise session may protect the cardiovascular system for two to three hours. "In essence, you are training your heart to be more resilient. ( This may happen because your body increases the level of nitric oxide which dilates the blood vessels and decreases inflammation.) But this protection likely depends on reaching a certain intensity of exercise. To make your heart work hard enough to activate the metabolic molecular pathways responsible for preconditioning the heart, you need to engage in moderate to vigorous exercise.

ECP may fill the gap between your desire to exercise and your ability to exercise. It is a massage-like therapy that has proven to benefit when synchronized with the heart’s rhythm. Some evidence suggests IECP can help induce the formation of collateral vessels in the coronary artery tree by stimulating the release of nitric oxide and other growth factors within the coronary arteries.

There is also evidence that IECP treatment may act as a form of passive exercise, leading to the same sorts of persistent beneficial changes in the autonomic nervous system that are seen with real exercise

(The known facts)
WHO IS THE IDEAL IECP THERAPY PATIENT?

One has undergone an angioplasty or a bypass surgery, but his symptoms of breathlessness and chest pain have recurred while he is on his prophylactic medication.

One who has undergone a heart attack needs intervention. but has more than 50% of his cardiac muscle dead, as a result of that heart attack. This is usually diagnosed by poor heart function on echocardiography (<35%) or by a nuclear cardiac test which shows cardiac muscle.

One has a high risk of surgery due to diabetic renal failure, stroke, liver failure, and extensive peripheral or diffuse heart blood vessel disease. One who is of an older age group (>70 years) in whom surgery might be of a higher risk;

One has advised a second bypass surgery due to failed vein grafts. One who might be advised bypass surgery or angioplasty and knowing its benefits does not want to do an interventional treatment out of his own choice. (Though this is not one such indication that should be encouraged without proper explanation).

One who has no critical blocks but is in no position to exercise due to being overweight and wants to get back to an active lifestyle and needs to have a good start. This could be an effective adjuvant to other lifestyle and risk factor modifying techniques.

EFFECTS OF IECP THERAPY

Overall IECP helps cardiac patients by First, reducing the workload of the heart. Secondly by increasing blood flow to the heart via collaterals and activation of dormant vessels. Thirdly, it stimulates the effect of drugs and exercise, thereby slowing the progress of the cardiovascular disease.

Finally, the cumulative outcome is on the patient's quality of life. Most patients have marked improvement or complete remission of chest pain and breathlessness can walk more distance, can be more active in life and live life more fully. IECP therapy has helped numerous patients who have been advised to restrict themselves to lead a full life.

The clinical data supporting IECP therapy is gaining momentum over the past five years. There are more than 160 journal articles published in Internationally reputed journals. Cardiologists and physicians in developed countries like the US and UK discuss the effectiveness of ECP. But still, ECP is seldom mentioned as an option unless the patients firmly asked about it.

IECP after Bypass surgery or Angioplasty As far as heart disease is concerned, medication can slow the progress of the disease and provide clinical improvement and interventional procedures do improve quality of life for a time period. But it is not a permanent cure. Every bypass patient has to pursue an active exercise regimen with a healthy lifestyle if they hope to sustain the benefits of the surgery or treatment they have received. If long-term sustained exercise training is not provided after the treatment, the disease may again surface and adversely affect the bypass grafts. This is how a repeat block in the artery or the stent happens.

Many cardiologists and physicians recommend IECP when the graft gets obstructed and the stent is closed as the first option rather than recommending yet another bypass or angioplasty. IECP is recommended during this course of the disease to stimulate the natural mechanism to promote new vessel formation around blocked arteries. So it is called "A NATURAL BYPASS. Unfortunately, by this time the disease would have grown to the aggressive stage and the patient is termed as inoperable or as a no-option patient. There is only one option IECP facts that every cardiac patient should know about.

SAFE:

This is one of the biggest benefits that it's a safe alternative to a more risky and invasive procedure.

SCIENTIFIC:

Scientific studies have shown ECP to be as effective as bypass or angioplasty procedures in selected patient groups. ECP is USA FDA-approved for chest pain and poor heart function and is the first truly noninvasive outpatient treatment.

PROVEN:

IECP has been proven to improve blood flow to the heart improve cardiac function Improve vascular health decrease and sometimes eliminate cardiac symptoms increase blood flow to other parts of the body

AVAILABLE:

IECP is practised in major hospitals worldwide. The physician is bound to tell the patient all options for managing the patient's disease and to have an unbiased dialogue with patients Those who don't include IECP are definitely withholding information. Currently, only a fraction of patients who could immensely benefit from the treatment is referred to IECP. When we have a treatment which has nothing negative about it and has shown amazing clinical benefits it's shocking to note that it's still sparsely used, The Option for Patients with NO Option The famous terminology adopted is "IECP IS AN OPTION FOR PATIENTS WITH NO OPTION" or “ WHEN NOTHING WORKS IECP WORKS”.

Even at this seemingly end stage, IECP therapy gives many benefits to the patient. The irony is that doctors still hesitate to provide or recommend IECP therapy during the initial phase of the disease. Ideally, treating cardiac disease should focus on not just the patient's cardiac health, but on restoring vascular health. We all know that a block in the blood vessels carrying blood to the heart leads to the poor blood supply, which in tum leads to heart attack and further complications. What we have not understood is that block has been created by the dysfunction of the entire vascular system; it's not just a malfunction in the vascular supply to the heart alone. If the patient has poor vascular health, the chance of getting a heart attack is high irrespective of how mild or severe the blockages are.

That is why interventional treatments like bypass surgery and angioplasty which restores cardiac health are always combined with regular exercise, risk factor modification and medications which are all shown to restore vascular health. Which is what IECP also does.

IECP treatment is the only treatment available at present which can increase the blood flow to the heart muscle similar to bypass surgery or angioplasty. The only point of debate within the clinical circle is whether the improvement is comparable to what has been achieved by intervention procedures like bypass surgery and angioplasty. The treatment is not a replacement for bypass surgery or angioplasty but if used judiciously it can help many patients to choose interventional procedures only when unavoidable.

Who should not Undergo IECP?

IECP therapy can be administered safely to patients of any age between 20 to above 100 years. But patients with the below-mentioned structural problems should not be taken up for IECP therapy. Patients with severe aortic valve problems. Patients in active heart failure or medically termed pulmonary oedema should wait until they have stabilized. Patients with big blocks in the lower part of their aorta having blocks called "Horse Shoe thrombus' may not be good candidates for IECP therapy.