FAQ ABOUT EECP / ECP AND BCA TREATMENTS:
What EECP / ECP does?
ECP increases blood flow not only to heart, but other vital organs as well :
- To heart by 20-42%
- To brain by 22-26%
- To kidneys by 19%
ECP also increases heart’s output (stroke volume) by 12% by reducing afterload. This improves LVEF or Ejection Fraction of the heart.
How long does ECP take?
The standard course of treatment is one hour per day, five days per week, for seven weeks (a) total of 35 one-hour sessions). Some patients have two treatments in one day in order to complete the program more quickly. Some patients extend the program beyond 35 treatments, depending on their particular medical situation and goals.
What are the advantages of ECP?
Well when it comes to treatment of heart disease, the first thing that comes to anybody’s mind is angioplasty, stenting or lastly bypass surgery.
Unlike bypass surgery, balloon angioplasty, and stenting procedures, ECP is non-invasive, carries no risk, is comfortable, and is administered in outpatient sessions.
What does ECP Do? How does it Work?
As mentioned earlier, ECP works by mainly three processes:
- Dilating blood vessels – Blocked & Small blood vessels enlarge.
- Opening dormant blood vessels lying closed sincebirth.
- Angiogenesis -Forming new blood vessels (what medically known as Collaterals)
Now what is this collateral circulation?
Formation of network of tiny blood vessels, which make it possible for blood to detour around blocked or narrow arteries, is called collateral circulation. However the development of collateral circulation is a gradual process and not everyone has the same ability to develop these networks at the rate that will relieve angina. ECP treatment triggers and accelerates this collateral circulation and makes it permanent in every person who receives complete treatment.
How to know if treatment has helped me?
- Patients Angiography would should lesser blockage than before treatment.
- Patient can walk more distance without chest pain
- Patient would have fewer or no angina
- Episodes of angina would be less painful
- Patient can return to work and can participate in their active life style once again
- Patient would be more energetic and confident.
Are there any risks or side effects of ECP?
ECP is safe. Occasionally, some patients experience mild skin irritation under the areas of the blood pressure cuffs. Experienced ECP therapists address this irritation by using extra padding to make the patient comfortable. Some patients experience a bit more fatigue at the beginning of their course of treatment, but it usually subsides after the first few sessions. In fact, patients typically feel energized by ECP.
What happens if I miss a treatment?
You are encouraged to come for your ECP treatment every day. However, missing a day will not have a negative effect on your overall results. When you come back, you will simply pick up where you left off, and the missed treatment will be added to the end of your program until you have a total of 35 sessions. Just like exercise, the more consistent you are with your ECP schedule, the better your results will be.
What does ECP feel like?
ECP feels like a deep muscle massage to your legs. During the treatment. You do not feel anything in the chest or heart. You only feel the cuffs that are wrapped around your legs squeezing in time to your own heartbeat. Our patients have affectionately described this sensation as “gentle hug”. Most of our patients relax, listen to music, or read during their treatments. Some even sleep!
Do the benefits of ECP last?
Yes, In patients followed for three to five years after treatment, the benefits of ECP, including less angina, less nitroglycerin usage, and improved blood flow patterns documented on stress tests, had lasted. If you ask us, for severe cases we recommend to undergo ECP treatment of 35 sessions every year for long lasting results.
How successful is ECP treatment?
This treatment is famous overseas in western country and more than 90% patients receiving treatments have improved. Most feel better in 15 to 20 sessions of the treatment. ECP benefits last 3 to 7 years or more, depending up on your lifestyle. ECP is so successful, that in USA insurance reimbursement for ECP has gone up by 6% whereas that for other procedures like angioplasty, bypass surgery etc, has decreased by 5% .
How does ECP compare to angioplasty or bypass surgery?
For a patient who has an event of Myocardial Infarction or severe coronary blockage, for immediate relief angioplasty/stenting or even bypass surgery is needed as ECP cannot provide immediate relief. But once out of emergent condition, patient should undergo ECP to revitalize ischemic muscle tissue, halt further worsening and avoid further complications of Myocardial Infraction.
Is ECP a recognized treatment?
ECP is internationally recognized by FDA (USA), CE Mark (Europe) etc. ECP is mentioned in medical textbooks. Many articles have been published in the journal of the American College of Cardiology, Cardiovascular Reviews Reports, Cardiology, Mayo Clinical Proc., Clinical Cardiology, Journal of External Counter Pulsation, etc.
Does ECP give symptom relief as Bypass and Angioplasty?
ECP results are even better than Bypass and Angioplasty. All these current mode of treatments help the heart by increasing the blood flow to the area of the heart muscle not receiving adequate blood supply. Once the blood supply is increased towards normal the patient’s chest pain will be decreased or eliminated and his exercise tolerance will improve. However, only via ECP hearts natural mechanism of forming new vessel is enhanced which markedly increase the blood supply to the heart muscle. ECP also tends to improve your endothelial cell function that lines your coronary arteries, which determine your chance of getting heart attacks. ECP decrease your heart rate and other Neurohormones, which damage the heart muscles.
Can a patient, who had undergone stenting/bypass surgery, go for ECP?
Yes, of course. Despite the patient had undergone bypass/stenting, the future risk always remains because the disease process of atherosclerosis not only involves the major coronaries , but also its tiny branches which cannot be dilated or undergo stenting due to limitations of the procedure . Also the atherosclerosis can involve the bypass graft in due course of time. Majority of patients undergoing stenting /bypass, land up in undergoing repeat stenting of the other coronaries or repeat bypass surgery, despite regular medications. Therefore, we recommend that a patient who had undergone stenting or bypass , should take sessions of ECP on once a year basis for two to three years, for best outcomes.
Do I need any investigation to be done after the treatment?
We highly recommend after treatment tests as a follow up. Some patients want to visualize the post ECP treatment improvement when compared with their previous reports. They can repeat their Exercise TMT or Echocardiography or Nuclear scan after the treatment. Some physician might feel follow-up test is unnecessary since the patient symptomatic clinical improvement itself has demonstrated increase blood flow to the heart muscle.
Do I need anything special to prepare myself for the treatment?
ECP is a safe, out-patient, non-invasive treatment. So you don’t have to restrict any of your daily routine work. You can fix your one-hour time treatment schedule according to your convenience. Before you start the treatment you will be asked to wear right clothing to prevent skin irritation and abrasion.
I have a pacemaker. Is that a problem with ECP?
No. Pacemakers and internal defibrillators do not interfere in any way with ECP.
I am on Coumadin/warfarin Is that a problem with ECP?
No. Patients on Coumadin are able to undergo ECP treatments safely.
I have congestive heart failure (CHF). Is that a problem with ECP?
No. In fact, in July 2002 the FDA approved ECP as a treatment for congestive heart failure (CHF). After completion a course of ECP treatment, Patients with CHF typically have less swelling in their legs, less shortness of breath, less fatigue, and often require less diuretic medication.
Can ECP dislodge plaque and cause a stroke or heart attack?
No. Our bodies obey the laws of physics, and one principle law is that fluid will follow the path of least resistance. Atherosclerotic plaques are calcified and hard, and they create an obstruction that detours the blood through alternate routes. During ECP, when your blood is flowing to your heart, it will naturally bypass arteries with plaque and enter healthy, non-diseased around the blockages is a longer trip, but it is a much earlier one. In time, these new pathways are reinforced and become lasting routes for blood to reach your heart beyond the blockages. Every ECP patient has had multiple, serious blockages. No one has ever had a heart attack or a stroke as a result of the treatment.
Are there any patients who are not able to have ECP?
There are very few patients who are unable to have ECP. Those who should not be treated include pregnant women, individuals with a severe leakage in their aortic valve requiring surgical repair, and patients with an active blood clot in their leg.
I had a blood clot in my leg three years ago. Can I have ECP?
Yes. Having a history of a blood clot (Deep Venous Thrombosis or DVT) in your leg does not preclude you from having ECP. It is recommended that you have Doppler ultrasound of your leg to confirm the blood clot has resolved before beginning the ECP program.
Does ECP aggravate high blood pressure (hypertension)?
No. If you have hypertension that is properly managed, you may undergo ECP without difficulty. Oftentimes, 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.
I have bad circulation in my legs (peripheral vascular disease or PVD). May I still have ECP?
Yes, and you should! ECP improves blood flow throughout the entire body, including your legs. If you have poor leg circulation, you might need more than 35 treatments. Many patients typically require at least 50 treatments to get the full benefit of the program. In addition to improved stamina, less angina, and less nitroglycerin use, patients with PVD have a marked improvement in their leg circulation in response to ECP.
I have atrial fibrillation and an irregular heartbeat. May I still have ECP?
Yes, An irregular heartbeat, including one caused by atrial fibrillation, will not interfere with ECP if the heart rate is controlled and no faster than 100 beats per minute.
What happens if my angina returns months or years after I finish my ECP treatment course? Can I come back for more?
Yes. ECP is not a once-in- a- lifetime treatment. Heart disease is a chronic illness and symptoms may return at some point in the future. The door is always open for you to return for additional courses of ECP as needed.
What should I do after ECP treatment?
To prevent the progression of your disease after completion of the treatment you should make life style changes like
- Quitting smoking
- Following heart friendly diet
- Controlling obesity
- Doing Regular exercise
Have regular follow-ups with your cardiologist to lower your cholesterol, to control your blood pressure and diabetes. ECP treatment provides you with new blood vessels. It is up to you to prevent your vessel from developing obstruction again.
What is BCA (Biochemical Angioplasty)?
BCA or what medically called Chelation Therapy is a chemical process in which a substance is used to bind molecules, such as metals or minerals, and hold them tightly so that they can be removed from the body. Chelation has been used to rid the body of excess or toxic metals like lead, which play a key role in worsening coronary atherosclerosis.
The use of disodium EDTA for heart disease has for about a decade to treat heart disease and other diseases grew, however, in the United States by nearly 68 percent, to an estimated 111,000 people using it annually.
Is chelation therapy Safe?
It is a really safe procedure, provided given under monitoring as in some patients any fast infusion results minor reactions like feverishness, headache, and nausea. It is relatively contraindicated in patients with severe grades of renal failure. Patients with drug reactions will be checked for sensitivity before treatment.
Who should get the Chelation therapy? Do all patients undergoing ECP need it?
It is to be decided by the cardiologist/doctor deciding your therapy on the basis of your clinical profile and coronary status. Some blood tests are required before taking decision for the chelation therapy.
No, it is not needed by every patient. Although patients with no contraindications, can safely opt for BCA in addition.