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Enhanced external counterpulsation for refractory angina pectoris
  1. R M Sinvhal1,
  2. R M Gowda1,
  3. I A Khan2
  1. 1Division of Cardiology, Beth Israel Medical Center, New York, New York, USA
  2. 2Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
  1. Correspondence to:
    Dr I A Khan, Creighton University School of Medicine, Division of Cardiology, 3006 Webster Street, Omaha, Nebraska 68131, USA;


Enhanced external counterpulsation (EECP) is a non-invasive outpatient treatment used for angina pectoris. In patients with intractable angina refractory to aggressive surgical and medical treatment, several novel strategies are considered including EECP, transmural laser revascularisation, and spinal cord stimulation. EECP produces an acute haemodynamic effect that is presumed to be similar to that produced by the invasive intra-aortic balloon pump. By applying a series of compressive cuffs sequentially from the calves to the thigh muscles upon diastole and rapidly deflating the cuffs in early systole, an increase in diastolic and decrease in systolic pressure is created. Although data indicate improvement in angina in patients undergoing EECP, the role of EECP in the treatment of angina pectoris has not yet been well defined. At present, EECP use should be limited to patients with debilitating (functional class III and IV) refractory angina pectoris who are not candidates for revascularisation, are symptomatic despite being on maximal antianginal pharmacotherapy, and have no contraindications to EECP use.

  • enhanced external counterpulsation
  • refractory angina
  • angina pectoris
  • ischaemic heart disease
  • coronary artery disease
  • EECP, enhanced external counterpulsation
  • IEPR, International EECP Patient Registry
  • MUST-EECP, multicenter study of enhanced external counterpulsation
  • TIMI, thrombolysis in myocardial infarction

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