Enhanced external counterpulsation (EECP) therapy is chest pain therapy approved by the Food and Drug Administration (FDA). It treats long-term chest pain or pressure (chronic stable angina) that doesn’t respond to other treatments. EECP therapy may also be recommended for some people who need a procedure to restore blood flow to their heart and aren’t eligible for surgery.

EECP therapy uses pressure to improve your blood flow. It’s a noninvasive, outpatient treatment. You typically receive the treatment over seven weeks.

This type of therapy can reduce your need for medication and increase your ability to be active without experiencing symptoms. Side effects are usually minor. Your healthcare provider can help determine if you are eligible for EECP treatment.

Angina is a sign of coronary heart disease that affects more than 10 million Americans. When you have angina, your heart doesn’t receive enough oxygen-rich blood due to narrowed or blocked arteries. In chronic stable angina, symptoms such as chest pain or weakness come and go when you are active or under stress.

Your healthcare provider may recommend EECP if you have:

• Chest pain.
• Cough.
• Fatigue.
• Shortness of breath (dyspnea).

EECP can also help other conditions, including:

• Cardiac syndrome X (a type of angina).
• Cerebrovascular disease.
• Heart failure.
• Kidney (renal) failure.
• Left ventricular dysfunction (an early stage of heart failure).
• Lung disease (pulmonary disease).
• Peripheral artery (vascular) disease (PAD).

EECP cannot treat unstable angina (acute coronary syndrome). This type of angina causes more severe, more frequent and longer-lasting symptoms. Symptoms develop suddenly, even while you rest.

Call 911 or have someone take you to the nearest emergency room if this occurs. You could be having a heart attack.

EECP treatment applies pressure to blood vessels in your lower limbs. The pressure increases blood flow back to your heart, so your heart works better. When your heart pumps better, symptoms ease.

This type of therapy can also encourage blood vessels to open new pathways for blood to flow to your heart. These pathways eventually become “natural bypass” vessels that help relieve symptoms of angina if your coronary arteries are narrowed or blocked.

You may be eligible for EECP therapy if you:

• Have long-term chest pain or pressure that comes and goes during physical activity or stress.
• No longer experience relief with medication.
• Don’t qualify for an invasive procedure like surgery.
• Experience renewed symptoms after an invasive procedure such as bypass surgery, angioplasty or stenting.

Talk to your healthcare provider about whether you qualify for EECP therapy. EECP therapy isn’t recommended for people who are pregnant. Providers may recommend other options for people who have pacemakers or conditions such as:

• Aortic insufficiency.
• Atrial fibrillation (Afib).
• Blood clots.
• Congenital heart disease.
• Enlarged heart (cardiomegaly).
• Heart valve disease.
• Hemorrhage.
• High blood pressure (hypertension).
• Irregular heartbeat.
• Fast heart rate (tachycardia).
• Hypertrophic cardiomyopathy.
• Pulmonary hypertension (PH).
• Severe peripheral vascular disease.

Before you receive EECP therapy, a healthcare provider performs a physical exam and exercise stress test. Your provider also explains the procedure and equipment involved.

Immediately before treatment, a provider:

1. Asks you to empty your bladder and change into special treatment pants.
2. Places three electrocardiogram (EKG) patches on your chest and inflatable cuffs around your legs and buttocks. The cuffs connect to air hoses.
3. Gives you a finger sensor to check blood oxygen and pressure levels, so providers can adjust therapy for best results.

During EECP therapy, you relax or nap on a padded table while air fills the cuffs around your lower limbs. You’ll feel the cuffs grow tighter around your legs and bottom until they reach full treatment pressure.

EKG and blood pressure monitors synchronize inflation and deflation with your heartbeat. The cuffs inflate as soon as your heart rests, increasing blood supply to the arteries that deliver blood to your heart. Then they quickly deflate to make it easier for your heart to pump again.

Once you get used to the sensation, therapy should be comfortable. It shouldn’t cause pain or discomfort. You can return to your regular daily routine after treatment.

EECP therapy is an outpatient treatment. You usually have it for a total of 35 hours: one hour a day, five days a week, for seven weeks.

You can also have it twice daily for three and a half weeks. You have a one-hour session, a break and then another session.

Responses to EECP therapy vary. You may feel tired for several days after treatment. Most people say symptoms feel improvement in the last couple of weeks of the seven-week treatment.

Talk to your healthcare provider if your symptoms return. About 20% of people need repeat EECP therapy, especially if they didn’t complete the initial 35 hour course.

Research shows many people report improved symptoms for up to a few years after EECP treatment. They say they experience:

• Fewer and less frequent symptoms of angina, including chest pain.
• Increased energy.
• More ability to be active or exercise without symptoms.
• Reduced need for medication.

EECP therapy doesn’t require a hospital stay. You can return to your regular routine immediately after treatment. Alert your healthcare provider if you experience any side effects.

Many people experience improved blood flow and reduced symptoms of angina for several years after treatment. In some cases, you may need another course of EECP therapy.