ECP Therapy

ECP therapy is a non-invasive & Pain-less treatment that helps alleviate symptoms of angina by increasing blood flow to thecoronary arteries and heart muscle. ECP helps re-vascularize the heart muscle through the development of collateral vessels.Collateral vessels help to increase blood supply to the heart muscle. ECP also helps in Heart Failure Recovery & StrokeRecovery. ECP helps significantly to improve LV function.

Studies indicate that ECP increases myocardial perfusion by 20-42%, cerebral vascular flow by 20-26% and renal flow by 18-20%


  • Angina
  • Breathlessness
  • Long Standing Hypertension (Increased Blood Pressure)
  • Myocardial Infarction (Heart Attack)
  • Cardiogenic Shock
  • Cardiac Syndrome X
  • Congestive Heart Failure (CHF)
  • Coronary Artery Disease (CAD)


ECP works in three simple stages: -

Stage 1 – ECP machine acts as a pump, sending oxygenated blood to the heart during diastole (when the heart is resting).

Stage 2 - ECP machine cuffs relax just before the heart pumps, decreasing the resistance in the blood vessels and thereby the afterload on the heart.

Stage 3 - The consecutive 35 sessions of this therapy improves micro-vasculature of the heart by stimulating angiogenesis and improving overall blood supply to the heart.


External counter pulsation has produced positive effects in patients with coronary artery disease. Some of the benefits are as given below:

  • Relief from chest pain or symptoms
  • Decrease in breathlessness
  • Possible increase in heart pumping capacity (EF)
  • Reduction in the need for anti-anginal medications
  • Improvements in lifestyle activity levels
  • Improves ability to return to work, life becomes 'normal'

An analysis of data on Ejection Fractions (EF) measured before and after an ECP program in 50 heart failure patients showed a remarkable 22% improvement, which is statistically significant.

Pre EF 31.90% Post EF 48.50%

I have already had bypass surgery/angioplasty/stents. Can I still have ECP?

Yes. The majority of our patients on ECP therapy have already had coronary angioplasty with stents (PCI) and/or CABG surgery. They received ECP therapy because of recurrent angina pectoris or similar symptoms despite medical therapy and/or revascularization.

Can a patient with varicose veins have ECP?

Yes. Varicose veins do not preclude individuals from receiving ECP. We often use extra padding in patients with varicose veins to ensure maximum comfort. However, if the diagnosis of deep vein thrombosis is entertained, a venous US Doppler study of the lower extremities should be performed before ECP.

Can a patient with peripheral artery disease have ECP?

Yes. ECP improves blood flow throughout the entire body, including the lower extremities. In our experience, patients with this condition –if not severe- may require more than 35 ECP sessions to obtain the full benefit of the therapy. We have documented with arterial Doppler studies the circulation of the lower extremities, before and after ECP in some patients with diabetes -with marked improvement in response to ECP.

What happens if angina returns months or years after a patient finish ECP treatment course? Can he / she come back for more?

Does ECP aggravate high blood pressure (hypertension)?

Patients with hypertension find that their blood pressure improves as they proceed with ECP. If your hypertension is uncontrolled, you must seek medical care to get your blood pressure under control with proper medications before proceeding with ECP. As a matter of fact, ECP has a therapeutic role in the management of arterial hypertension and hypertensive heart disease.

Is there an age limit for ECP?

No. We have successfully treated patients as young as 35 and as old as 86 without any difficulties. Many of our patients are in their 80s and complete the entire ECP program with excellent results.

Can EECP dislodge plaque and cause a stroke or heart attack?

No. Atherosclerotic plaques are calcified and hard, and they create an obstruction that detours the blood through alternate routes of least resistance. During ECP, when blood is flowing to your heart, it will naturally bypass arteries with significant plaque and enter healthy, non-diseased blood vessels to go around the blockages. In time, these new pathways are reinforced and become lasting routes for blood to reach your heart beyond the blockages. This is why; ECP is often called the “natural bypass.”

What happens if a patient misses an ECP session?

Besides angina, does ECP have been useful for other non-cardiac conditions?

In our experience, ECP has been useful for other non-cardiac conditions such as erectile dysfunction, renal failure with fluid retention refractory to diuretics, and obesity associated with fluid retention as well. At the present, it has been described that ECP has a therapeutic role in the treatment of restless leg syndrome, hepatorenal syndrome, erectile dysfunction, syndrome X, and retinal artery occlusion.

What to Expect

EECP isn’t invasive. It’s also an outpatient therapy.

You lie down on a padded table in a treatment room. Three electrodes are put on your chest and connected to an electrocardiograph. That displays your heart's rhythm. Blood pressure is also tracked. A set of cuffs is wrapped around your calves, thighs, and buttocks. They attach to air hoses that connect to valves that inflate and deflate the cuffs.

Preparing for External Counter Pulsation Treatment

No preparation is necessary for ECP. In most cases, the procedure is done on an outpatient basis. It is suggested that patients wear clothes that are tight-fitting and elastic to prevent irritation from the cuffs and follow medication and exercise instructions as directed by their physician.