Enhanced external counterpulsation for chronic myocardial ischemia: How to use a nonpharmacologic, noninvasive treatment for patients with angina

Enhanced external counterpulsation (EECP) produces sequenced compression of the lower extremities during diastole. The 'milking' effect on the arterial beds of the lower extremities augments aortic diastolic pressure and thereby increases coronary perfusion pressure and blood flow. The simultaneous compression of venous beds increases venous retum and cardiac filling pressure. EECP treatment of patients with chronic angina can improve myocardial perfusion as demonstrated by radionuclide stress imaging, time to significant ST-segment depression during exercise testing, and functional status. EECP may be especially worth considering for patients with severe, diffuse coronary artery disease in whom targets for surgical revascularization are lacking and those who have persistent angina after 1 or more revascularization procedures.