Over the past few years the method of enhanced external counterpulsation (EECP) has won a firm place in the treatment of patients with coronary heart disease (CHD) and chronic heart failure (CHF).
Enhanced external counterpulsation (EECP) - non-invasive, safe and noninvasive method to achieve the increase in coronary perfusion pressure (cerebral, femoral, mesenteric, renal, etc.) arteries during diastole of the heart and reduce the resistance of cardiac ejection during systole.
In modern systems, EECP for this purpose on the patient's leg cuffs are applied, in which the heart during diastole, at high speed on the rise of the calf - the lower part of the thigh, and then - to the upper part of the buttocks and pumped the air with subatmospheric pressure (200 - 280 mm Hg. cent.) synchronously with the heart rhythm. This leads to a retrograde arterial blood flow and an increase in diastolic pressure in the aorta, which in turn leads to an increase in coronary perfusion pressure and increased myocardial perfusion (similar effects are observed in the basins of the carotid, mesenteric, renal arteries, etc.).
Also, there is an increase in venous return to the right heart. Instant pumping air from the cuff at the beginning of ventricular contraction lowers vascular resistance and, hence, reduces the heart. The increase in perfusion pressure during diastole leads to the discovery and development of collateral vessels and increased blood supply to organs and tissues.
According to statistics, during the positive effect of EECP can reach 80 - 90% of patients with coronary artery disease.
To date, there is strong evidence of positive effects of EECP on both systolic and diastolic left ventricular function.
Research Prospective Evaluation of EECP in Congestive Heart Failure demonstrated high efficacy and safety of using the method of EECP in treatment of congestive heart failure. Key findings are as follows: 1) the background of EECP on optimal medical therapy increases exercise tolerance and improves quality of life and reduces the functional class of heart failure, 2) is well tolerated by patients with CHF, and therefore recommended for use in the treatment of patients with compensated with using drugs with CHF II-III functional class as coronary and noncoronary nature.
Extrapolating the positive results obtained by applying the EECP in cardiology for the treatment of patients with coronary artery disease and heart failure, has substantially expanded the scope of effective methods: the impressive results obtained in patients after ischemic stroke, transient ischemia suffering a brain. A promising method is the use in patients with diabetic angio-and polyneuropathy. In addition to these very serious problems in the area of application of EECP were and some others. For example, the rehabilitation of professional athletes.
Recommended indications for EECP include:
Angina II - IV FC, including those resistant to conservative therapy
Recurrence of angina after myocardial coronary artery bypass surgery, stenting Atherosclerosis of peripheral arteries
Ischemic diseases of the eye (thrombosis of the central artery of the retina, ischemic damage to the optic nerve, chorioretinopathy, retinitis)
Erectile dysfunction of vascular origin
The increase in exercise tolerance in athletes
By contraindications for EECP include:
Severe valvular pathology (severe aortic valve regurgitation)
Thrombophlebitis (phlebemphraxis), severe varicose veins, trophic ulcers of lower extremities
Severe uncontrolled hypertension (> 180/110 mm Hg. Art.).
Malignant cardiac arrhythmia with a heart rate> 135 or <35 beats per minute
Severe pathology of the central and peripheral vascular
Cardiac catheterization in less than two weeks ago
Hemorrhagic diathesis, therapy with indirect anticoagulants MHO (international normalized ratio) greater than the target values
High pulmonary hypertension
Obviously, enhanced external counterpulsation - a method with great therapeutic potential, this beautiful and wonderful future. For more than a year and a half room EECP has successfully worked in the Department of Rehabilitation Medicine at our clinic.