Information Concerning Recognized and Little-Known Treatment
For People With Serious Heart Problems

This site has been established for the purpose of providing information for people with certain heart problems. This information can mean the difference between life and death for some people—as it has been for the originator of this site.

Non-Invasive Medically-Recognized Treatment For
Angina Due to Coronary Artery Blockage

Their is a non-surgical, non-invasive treatment for such coronary conditions as:

• Angina. The most common medical condition for which EECP has been used.
   

• Congestive heart failure, a less-common condition for which EECP has been used. However, there are encouraging medical studies showing significant improvement in the quality of life when EECP has been used.
   

• Other coronary conditions, especially those associated with poor blood circulation. The treatment is something like a natural bypass for severely blocked coronary arteries.

The treatment creates additional paths for blood flow, called arterioles or collaterals, to provide additional pathways for blood flow to the heart that circumvents blocked arteries. In this way the treatment restores or improves the blood circulation to organs and tissues that have been affected by blockage in the normal blood supply.

The treatment is known as EECP or Enhanced External Counterpulsation, and encourages the formation of coronary arterioles or collaterals that circumvents blocked coronary arteries.

An excellent book on EECP is called, Heal your heart with EECP by  Dr. Deborah Braverman.

Congestive Heart Failure and EECP

EECP has been found to benefit people with stable congestive heart failure in medical studies. The following is one of many articles on the subject:

In 2002, a new study, 26 patients with stable congestive heart failure were enrolled to receive a standard, 35 session course of EECP.  19 patients completed the EECP sessions and were followed for 6 months afterward.  These patients showed, on average, a significant improvement in their functional capacity and quality of life.  The authors point out, as well, that the EECP was well-tolerated in these patients. 

Since there were no control subjects in this small study, no firm conclusions can be drawn about how useful EECP might be in treating heart failure.  But the study was impressive enough to launch a larger, randomized clinical trial (the Prospective Evaluation of EECP in Congestive Heart Failure - PEECH - trial,) that should provide more definitive data on how well EECP might benefit patients with heart failure.  The PEECH trial has already begun.

Despite the fact that the potential benefits of EECP in heart failure are still being evaluated, the FDA was sufficiently convinced of these benefits that it cleared the makers of the EECP system (Vasomedical) to begin promoting EECP for heart failure.

Most cardiologists have not embraced the use of EECP for heart failure, quite justifiably citing the need for larger clinical trials.  However, since (as we have previously pointed out) cardiologists don't like EECP even when it is of proven benefit, patients with heart failure who are interested in this treatment option should watch for results of the PEECH trial, and if they prove positive, should take the initiative in bringing up the option of EECP to their doctor

Another article in 2002:

Sampling of links to discussion of EECP for congestive heart failure

http://cardiology.ucsf.edu/clinical/eecp/    University of California at San Francisco.

http://heartdisease.about.com/library/weekly/aa082602a.htm

http://findarticles.com/p/articles/mi_m0EIN/is_2002_August_9/ai_90245523/

For other links, put "EECP" or "EECP and congestive heart failure" in www.google.com search box.

Reported Major Key Benefits of EECP Treatment

• Reduction in frequency and severity of angina, or its elimination.
   
• Increased physical ability.
   
• Reduction or elimination of nitro glycerin or other medication.
   
• Improvement in mental well-being.
   
• Reduction of high blood pressure.
   
• Elimination of the need for the invasive open-heart surgery or stents. This is especially important--or life saving--for those whose physical condition does not permit open-heart surgery, balloon angioplasty, or stents. Or those who do not want to undergo any of those invasive procedures.
   
• For pilots, EECP treatment may prevent losing their FAA medicals as occurs following open-heart surgery.
   
• The increased blood flow following EECP treatment is reported helpful in other conditions.

Comments on Refractory Referral Decisions

Some physicians won't refer patients to EECP until they are in a "Refractory" status, meaning, that if such medication as pills, nitro patches, open heart surgery, or stents are not providing relief, then it is time to try EECP. In this person's opinion, who has had massive coronary blockage, just the reverse should be considered for the following reasons:

• EECP generates new paths for blood flow, physically improving the condition.
• Medication provides temporary relief while the drugs are working. But do nothing to generate new circulation.
  • Drugs do not physically provide any new blood vessels; they often have side effects; and nitro patches must be removed at night, with a return of angina.
  • Stents have risks associated with the procedure itself, and combined with threats of fatal blood clots.
  • Open heart surgery has risks associated with the procedure, and eventually one of more of the bypasses fail. If EECP was started earlier enough, it is very possible that there would never be any need for open heart surgery. For pilots, who often lose their Class I medical certificate when they have open heart surgery, the EECP treatment may avoid that loss of FAA medical.
  • Further, the cost for system-relieving angina drugs, and the drugs needed to thin the blood after stents, may in the long run exceed the relatively minor costs of a series of EECP treatments.

Although a series of 35 one-hour treatments may dissuade some patients, it helps to remember that the body itself is being improved, and that life may be extended, and the quality of life improved, by making this effort. Usually, watching television or listing to radio or tapes, using earphones, makes the time go by much faster, and provides the opportunity to either relax or catch up on whatever is set to come over the earphones.,

In some cases, the loss of money by hospitals and coronary surgeons from widespread use of EECP over open heart surgery or stents is a motivating factor for not promoting this low-cost treatment.

Top Medical Centers Using EECP Treatment

Some of the medical centers performing EECP treatment include the following:

• The Mayo Clinic.
   

• John Hopkins Medical Center.
   

• The Cleveland Clinic.
   

• Beth Israel Medical Center, New York City.
   

• University of California at San Diego.
   

• The Ochsner Foundation Hospital.
   

• JFK Medical Center, Atlantis, Florida.
   

• University of Florida at Gainesville.
   

• University of New York at Stony Brook.
   

• Kaiser Permanente of Denver.
   

• Trinitas Hospital, Baltimore.

An article in the American Journal of Cardiology, 2004; 89(7): 822-4 stated that an international group had evaluated the effectiveness of EECP treatment on patients with chronic stable angina, at several medical centers. The article stated that over 80 percent of people with stable angina received significant improvement from their angina symptoms and an increase in the flow of blood to the heart, which was accompanied by an increase in their exercise ability.

The cuffs inflate and compress in response to the early diastole signal of the heart and deflate to the late diastole signal.  The sequential cuff inflation creates a retrograde pressure wave the augments diastolic pressure, and this increases coronary perfusion pressure and venous return to the right side of the heart (which increases preload and cardiac output).

The University of Pittsburgh coordinated studies  that were reported in the International EECP Patient Registry (IEPR) that showed:

• About 75 percent of EECP treated patients achieved statistical significant improvements that included (a) improvement in quality-of-life; (b) significant improvement in ability to resume daily activities, including social interaction and recreational pursuits.

EECP was initially developed at the Harvard University. A Harvard Medical School study of EECP in diabetics  with or without congestive heart failure  showed EECP equally effective in both groups. The researchers found that the 70 percent of patients had a significant reduction in the severity of their angina; the number of angina episodes decreases, as well as reduction in the need for nitroglycerine.

Researchers in Germany discovered that elderly people, after receiving EECP treatment, experienced increased blood supply through the ophthalmic artery, which is a major artery providing most of the retina's blood supply. (Graefe' Archive for Clinical and Experimental Ophthalmology, 2001; 239(80); 599-602.

EECP treatment was approved by the FDA for angina and coronary artery disease in 1995 and FDA approved for congestive heart failure in 2002.  

Throughout the world over 100 scientific studies have been published in leading medical journals attesting to the value of EECP.

Nearly 1,000 physicians use EECP treatment.

Additional Benefits Reported by Some People Undergoing EECP Treatment

• Hypertension reduced, resulting in lower blood pressure.
   
• Improvement in peripheral vascular disease.
   
• Improvement in diabetic neuropathy.
   
• Improvement in memory.
   
• Improvement in vision problems in the elderly.
   
• Elimination of tinnitus (ringing in the ears).

People who Are Candidates for EECP Treatment

People who are candidates for EECP treatment, who can expect a high probability of improvements in their physical condition, include:

• People experiencing angina, stable and unstable.
   
• People whose medication, such as nitro patch, has lost their effectiveness.
   
• People suffering angina at night, after removing the nitro patch (necessary to avoid developing tolerance).
   
• People who must restrict their physical activities to avoid angina.
   
• People who have suffered a heart attack.
   
• People whose physical condition makes them unsuitable for invasive treatment such as open-heart surgery or stents.
   
• People who do not wish to undergo the invasive treatments.
   
• People who are at greater risk of complications after invasive treatment, such as the elderly, people with diabetes, pulmonary disease, renal dysfunction, or heart failure.
   
• People who have coronary anatomy problems  that put them at risk for open heart surgery or stents.
   
• People with diabetic neuropathy.
   
• People whose medication or invasive procedures have not provided relief, including angioplasty, or have failed.
   
• Other circulatory problems.

Further Information on EECP Sessions

EECP treatment is provided as an outpatient and consists of 35 one-hour treatments on consecutive days. Occasionally, additional treatments are recommended. Where travel is excessive, these treatments can be combined into two one-hour or a single two-hour session.

The treatments are easily tolerated. The person lies on a comfortable table with cuffs (similar to blood pressure measuring cuffs) wrapped around the legs and lower abdomen. To make the time go faster, the person often wears headphones and listen to local radio stations, recorded tapes, or music. Some read. And a very few, sleep.

The patient experiences the compression of the cuffs with every heart beat, which is not uncomfortable to most patients.

Patient comments: http://www.vasomedical.com/patients_testimonials.php

Video for EECP treatment: http://www.vasomedical.com/patients.php

Please, mention this site when going to a EECP facility.

Rare Heart Problems That Prohibit or Delay EECP Treatment

There are very few conditions that prevent or delay EECP treatments. Before the start of EECP treatment a physician checks the person for any condition that would bar such treatment. Among the conditions that would affect a person's suitability for EECP treatment include the following:

• Known aortic aneurysm that requires surgical repair.
   
• Pregnancy.
   
• Active thrombophlebitis.
   
• Bleeding diathesis.
   
• Arrhythmias that interferes with the triggering of the EECP machine.
   
• People with blood pressure higher than 180/110 mmHg must have their pressure lowered before treatment.
   
• People with a pulse greater than 120 bpm must have their heart rate lowered before treatment.

Additional Comments

For those new to the problem, angina is the most common symptom of coronary artery disease, and reflected in chest pain, chest pressure, shortness of breath, pain in the neck, the jaw, the arms, back, nausea, or fatigue. Failure to react to angina could result in a heart attack.

EECP develops arterioles or collaterals that go around blocked arteries. EECP increases blood flow throughout the body, and in that way it often relieves other symptoms than those associated with heart disease. EECP carries no risk; it is non-invasive.

For patients with congestive heart failure, EECP usually reduces swelling in the legs and shortness of breath and often reduces the amount of needed diuretics.

No age limitation.

An EKG controls and keeps in sync with the heart the compression of the cuffs. For instance, when the heart is resting and when it is receiving its supply of blood, the cuffs inflate, which pushes blood to the heart from the legs and lower abdomen. Then, just prior to your heart pumping, the cuffs deflate and the blood is pumped from the heart. When the heart stops pumping, the EECP compression accelerates the return of blood to the heart.

The most common treatment for angina is either one or more stents or open heart surgery. There are some conditions where one of those forms of treatment is preferable. They do have risks however, and these include death. One route a person may consider is to try EECP first and if that does not provide relief, then the more hazardous procedures can be considered.

For pilots, there might be a benefit in trying EECP first so as to possibly avoid problems with FAA physical certification.

Information spreads slowly in the medical profession. Many doctors have never heard of EECP treatment, despite the many studies and approval of the procedure (FDA, Medicare, and most insurance companies.) In these cases, it is up to the patient to bring the information to the attention of their doctor with a strong recommendation that referral to an EECP treatment center be approved.

Where a treatment location is beyond commuting distance, the normal seven week treatment can be cut in half by having two EECP treatments a day. The life-saving benefits more than justify renting accommodations near the EECP location during the treatment period, if necessary.

Safety Comparison

EECP treatments are safe, are done as an outpatient treatment, and does not involve any drugs or surgical intervention. Drugs have side effects. Invasive open heart surgery had risks. Invasive stent placement or balloon angioplasty have risks.

Some people feel that EECP treatment should come before the potentially hazardous open-heart surgery or stents.

Resistance from Many Doctors

Despite the fact that EECP is well proven, and used by top medical centers, most doctors are unfamiliar with this treatment. One reason for this is that the people selling the machines do not have detail people making periodic calls on physicians, as is done by the pharmaceutical companies. There isn't that much profit in the selling of a machine as there is in having doctors prescribe certain medication.

Another reason for resistance is that there is far more profit in insertion of stents or open-heart surgery. There is virtually no profit in referring a patient to a location that has the machine necessary for EECP treatment.

Guideline for People Wishing Medicare Referral for Treatment

Physicians examination is necessary to determine that there are no medical conditions that bars EECP treatment.

Selected medical terms for research:

• PCI.
   
• CABG (open heart surgery).

Contraindications to EECP

• No known history of aortic aneurysm requiring surgical repair, and no pulsitile mass in, the abdomen.
   
• No known history of bleeding diathesis based on recent blood count and coagulation panel.
   
• No known history of blood clots or lower extremity edema.
   
• No know history of claudification symptoms or severe PVD.
   
• If the patient is pre-menopausal, no pregnancy documented by a recent urine or serum pregnancy test.

More Information

To get information about the location of an EECP treatment source in Northern California, and primarily in the Walnut Creek area, send an email to information@heartsurvival.info. Or send a fax to 925-295-1203, and provide your name, address, and phone number. This information will be passed on to someone that will contact you.

The Provider of This Information

This site has been put up, at his expense, by Rodney Stich. He credits being alive for many years after coronary blockage had become so severe that he contacted a funeral home to make final preparations for his expected demise.

He had a six-bypass operation in 1985 that performed very well until the failure of one of the vein bypasses in 2003. He has partial relief from angina during the day with a nitro-patchy, but at night, after the patch had to be removed, the angina was strong.

His medical team stated that he was not a candidate for After this occurred, he had heavy angina even during the night. The open-heart-surgery that he had done in 1985, that required multiple bypasses, could not be repeated, nor could stents be inserted, the doctors said, because the vessels were too small. He was sent home from the hospital in 2001 to die. Nitro patches did not correct the all-night angina, often called terminal or unstable angina. (Stich is no youngster; he joined the Navy in 1940, a year before the Japanese attack upon Pearl Harbor.)

Fortunately for him, he discovered through Internet searches about EECP, and the first series of 35 treatments eliminated the angina. He was still no athlete, but he could continue his normal research and writing activities as if life was normal. For him, the improvement from the series lasted about seven months, after which he repeated the treatments. Once, he had to go 70 treatments for relief. But today, in July 2007, he is alive, four years after counting the remaining life, day-by-day.

He discovered the most physicians don't know about EECP, even though the treatment is recognized and used in key medical centers and overseas. He also discovered a somewhat unpleasant fact: those doctors who do know about it don't refer patients to it because of financial reasons: doctors and hospitals make millions of dollars a year on open-heart-surgery and stents, and have no intention of giving up this financial source.

Unfortunately, there are some patients that are not candidates for stents or open-heart surgery, and they are simply ignored.

Pharmaceutical companies make millions, and even billions, on doctors dispensing or prescribing their drugs, and certainly have no intention of diverting this cash-cow to a low-profit EECP treatment.

And the two companies in the United States that make the machines do not make sufficient profits to send detail personnel visiting doctors on a regular basis as doe the pharmaceutical companies.

For these reasons, Stich has put up this site to inform people of the treatment and the important need that they must advocate that their physicians authorize the treatment.

Stich can refer people to a reliable provider in the northern California area. People living elsewhere can find an EECP provider from the lists at this site.

Angiogram Showed Clinical Evidence of Value of EECP

A recent angiogram in San Francisco (August 2008) was compared to an angiogram for the same person done in 2003, and showed a significant increase in coronary collaterals. During this five-year time period, several series of EECP treatments occurred. The doctor doing the latest angiogram, prior to the angiogram, stated his disbelief in the EECP treatments. But, during about a hour of probing attempting unsuccessful to open any of the blocked coronary vessels, he stated that there were a considerable increase in the collaterals that had been keeping that heart patient alive.

That patient turned down the next scheduled angiogram that was to attempt drilling a hole in the blocked vessels and insert a coated stent. The reason for turning down the treatment, in lieu of additional EECP treatments, was (1) the requirement for Plavix or other blood thinner, to avoid a possible deadly clot (prior Plavix treatment resulted in major blood loss from a ruptured kidney cyst); and (2) because of the danger associated with the drilling procedure.

Information on Treatment Locations

For those seeking EECP treatment in Northern  California, either call 925-944-1930 or email to info@rodneystich.com.

If you wish to help us these efforts by donating whatever you care or can afford, it will help pay for the hosting site. You can make donations via Paypal using your credit card or your Paypal account.

Email address for Rodney Stich: stich@rodneystich.com.