External Counter Pulsation (ECP) Therapy

External counterpulsation therapy (ECP) is a procedure performed on individuals with angina or heart failure or cardiomyopathy in order to diminish symptoms of ischemia, improve functional capacity and quality of life.

In various studies, ECP has been shown to relieve angina, and decrease the degree of ischemia in a cardiac stress test.

While an individual is undergoing ECP, he/she has pneumatic cuffs on his or her legs and is connected to telemetry monitors that monitor heart rate and rhythm.

The most common type in use involves three cuffs placed on each leg (on the calves, the lower thighs, and the upper thighs (or buttock)).

The cuffs are timed to inflate and deflate based on the individual’s electrocardiogram.

The cuffs should ideally inflate at the beginning of diastole and deflate at the beginning of systole.

During the inflation portion of the cycle, the calf cuffs inflate first, then the lower thigh cuffs and finally the upper thigh cuffs.

Inflation is controlled by a pressure monitor, and the cuffs are inflated to about 200 mmHg.

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 circumvent the blocked arteries.

Many patients find that:
• less medication is required
• they have fewer angina attacks
• they can do much more physically such as walking, golfing and gardening
• life becomes more “normal”


  • Angina patients who are not relieved by medicine
  • Patients who don’t want to have bypass surgery
  • Patients who are contraindicated for bypass or angioplasty due to kidney failure, liver failure, severe COPD cases, diffuse diabetes disease, very old age, patients of Syndrome X, ischaemic and dilated cardiomyopathy


  • Severe aortic regurgitation or aortic stenosis
  • Deep vein thrombosis
  • Pregnancy
  • Very high blood pressure
  • Severe peripheral vascular disease
  • Possibility of stroke
  • Wait for 6 weeks after any surgery for ECPT.
  • Wait for two weeks after angiogram or angioplasty..
  • Uncontrolled arrhythmia or controlled arrhythmias that could interfere with ECP inflation and deflation triggering.
  • Dual chamber pacemakers where atrial pacing may interfere with ECP inflation timing sequence. This should be addressed prior to treatment.
  • Aortic insufficiency (regurgitation can prevent diastolic augmentation).
  • Severe pulmonary disease.
  • Limiting peripheral vascular disease involving the ileofemoral arteries.
  • Deep-vein thrombophlebitis ( risk of thromboembolus).
  • Severe hypertension (≥ 180 mmHg systolic or ≥110 mmHg diastolic).
  • Bleeding disorders.
  • Patients undergoing major anti-coagulation therapy (such as Heparin therapy or Coumadin® therapy) with PT > 1.5.
  • Heart rates less than 35 or more than 125 beats per minute(BPM). (Patients with these heart rates should be evaluated and treated prior to ECP treatments).
  • Presence of local infection, vasculitis of the extremities, or abdominal aortic aneurysm.
  • Pregnant women and women of childbearing age who do not have a negative pregnancy test.
  • Presence of a burn, open wound, or bone fracture on any limb subject to ECP treatment.

A physician should be consulted if in doubt.