Doctors using ECP more frequently

Published 12:00 am Friday, December 14, 2007

ASHLAND, Ky. — Doctors at King’s Daughter Medical Center are using a powerful tool to help patients suffering from heart-related illnesses, that, until recently, required surgical procedures to correct.

ECP, External Counterpulsation therapy, is a non-surgical alternative to traditional but invasive and often risky treatments, such as angioplasty and open-heart surgery, and with increasing frequency KDMC’s cardiologists are turning to it as a first option to combat acute cardiac problems.

KDMC head cardiologist Dr. Sriharsha Velury runs SV Cardiology from the hospital’s Heart and Vascular Center. He and the Center’s five cardiac staff physicians brought the therapy to the Tri-State area in 2005, where the procedure has met with great success.

Email newsletter signup

“The therapy is here. It’s a great therapy. I’ve seen the good it does,” said Dwayne Summers, SV Cardiology’s ECP Supervisor.

A health care professional for the past 18 years, Summers has overseen the program since January of 2007 and is eager to make the public aware of the therapy’s benefits.

He explained that problems arise when the heart is unable to produce enough oxygenated blood for the body’s use, a condition known as ischemia. External counterpulsation is a fairly simple concept: venous, or deoxygenated, blood is forced toward the heart to maximize the amount of arterial, or oxygenated, blood the heart is then able to pump to the rest of the body.

A person may suffer from heart disease because his heart is either unable to pump enough oxygen-rich blood through the bloodstream or because there is a blockage within an artery delivering the blood to the rest of the body. In both cases that reduced blood flow can result in serious, even life-threatening complications, such as angina pectoris (chest pain), heart attack, or congestive heart failure. ECP is used to treat anginal symptoms before the heart sustains severe or irreparable damage.

The therapy consists of attaching cuffs, similar to those used to take blood pressure, around the patient’s calves, thighs, and buttocks. Three electrodes are placed on the patient’s chest and attached to a machine with an EKG to monitor heart rhythm.

Once a regular heartbeat is established, upon diastole — when the heart fills with blood — the machine forces air into the cuffs, inflating them sequentially from calves to thighs to buttocks. As the air pressure in the cuffs increases, blood in the veins of the leg is compressed and forced upward toward the heart. This increased pressure pushes a greater quantity of blood through the heart, thus increasing the resulting output of oxygenated blood flowing from the heart.

When systole — the contraction of the heart — begins, the cuffs instantly and simultaneously deflate, as the heart squeezes oxygenated blood out to the rest of the body. Diastole begins again, again the cuffs fill with air, and

the cycle is repeated. This increased blood flow actually opens up other, smaller arteries, so if the heart problem is caused by an arterial blockage, these new vessels bypass that obstruction altogether, making it a viable procedure for some patients who would otherwise require angioplasty to break through the blockage.

The typical course of ECP therapy requires 35 visits, five one-hour outpatient sessions per week for seven weeks. Summers said many patients feel marked results within the first few sessions.

Jim Blevins of Raceland, Ky., is involved in the treatment.

“It’s like a good, strong massage,” he said, while the machine rocks him rhythmically back and forth. “My legs feel great when I’m done.”

Seventy-four-year-old Bennie Imes of Ironton gave a similar testimonial: “Prior to ECP I had such bad chest pain due to my heart attack, it was unbearable. After the first 10 sessions … I could feel the difference … and at the end of therapy I felt great. I now have more energy. I can now climb stairs and walk without chest pain or shortness of breath.”

Summers stressed that part of the beauty of the therapy is that it requires no anesthesia and has very few side effects.

“Some people have body aches, as the procedure simulates exercise. It’s essentially a cardio workout,” he said.

Otherwise, virtually the only other complaint he’s heard is that some people have chafing caused by the cuffs. To minimize this problem, patients wear treatment tights to reduce leg abrasion.

ECP therapy is not new, though it is only in the past few years that doctors have begun using the technique in earnest. ECP research in the United States actually began in the late 1950s, but it wasn’t until the mid-1960s that a device using the principle of counterpulsation became a means to alleviate the symptoms of angina.

After years of clinical studies, with results published in The American Journal of Cardiology, Clinical Cardiology, and other respected medical journals, the therapy has been proven effective and has since been reviewed and approved by the Food and Drug Administration.

Though not everyone suffering from heart disease is suitable for the procedure, ECP treatment may be a painless, effective way to relieve chest pain, improve exercise tolerance, and decrease the need for cardiac medications. Insurance companies are taking notice, too.

Because the cost of therapy is a fraction of that of surgery, Summers said that he has never had Medicare or any other insurer deny coverage to a qualified patient.