Ask The Doctor

Medlinks Cardiocare: Ask the doctor about EECO

Here, Dr. Ajith Joy K offers answers to some of the most commonly asked questions about EECP. If you do not see your questions or concerns addressed here, please email Dr Ajith Joy K at: He will respond to you directly as quickly as possible.

Q: What is angina?
A: Angina is the global term for all symptoms associated with coronary artery disease, which occurs when the heart is not receiving enough blood. It occurs when vessels that carry blood to the heart muscle become dysfunctional, and are often narrowed or blocked. Angina may feel like chest pain or pressure, shortness of breath, pain in the jaw, neck, arms, back, nausea, or generalized fatigue. Each patient experiences angina differently.

Q: What does EECP stand for?
A: The acronym EECP stands for Enhanced External Counterpulsation.

Q: What is EECP?
A: EECP is a non-invasive, outpatient treatment for heart disease that is used to relieve or eliminate angina. During the treatment, blood pressure cuffs are wrapped around your legs, and squeeze and release in sync with your heartbeat, promoting blood flow throughout your body and particularly to your heart. In the process, EECP develops new pathways around blocked arteries in the heart by expanding networks of tiny blood vessels ("collaterals") that help increase and normalize blood flow to the heart muscle. For this reason, it is often called the natural bypass.

Q: What are the advantages of EECP?
A: Unlike bypass surgery, balloon angioplasty, and stenting procedures, EECP is non-invasive, carries no risk, is comfortable, and is administered in outpatient sessions.

Q: Are there any risks or side effects of EECP?
A: EECP is safe. Occasionally, some patients experience mild skin irritation under the areas of the blood pressure cuffs. Experienced EECP therapists address this irritation by using extra padding where needed 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 EECP.

Q: How long does EECP take?
A: 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.

Q: When can I expect to start feeling better from EECP?
A: Most patients begin to experience beneficial results from EECP between their 15th and 25th treatments. These benefits include increased stamina, improved sleeping patterns, decreased angina, and less reliance on nitroglycerin and other medications. There is variation, certainly, and some patients start to feel better as soon as their first week of treatment!

Q: What happens if I miss a treatment?
A: You are encouraged to come for your EECP treatment everyday. 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 EECP schedule, the better your results will be.

Q: What does EECP feel like?
A: EECP 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 hugs." Most of our patients relax, listen to music, or read during their treatments. Some even sleep!

Q: Do the benefits of EECP last?
A: Yes. In patients followed for three to five years after treatment, the benefits of EECP, including less angina, less nitroglycerin usage, and improved blood flow patterns documented on stress tests, had lasted.

Q: How does EECP compare to angioplasty or bypass surgery?
A: The five-year outcomes for EECP patients are virtually the same as for angioplasty and bypass surgery patients.
(Please see our Clinical Studies page for more information.)

Q: Does insurance pay for EECP?
A: Yes. EECP is covered by Medicare and paid for by private insurance carriers. In India Tamil Nadu government has approved EECP for reimbursement. Currently many other insurance providers are looking at approving this therapy for coverage.

Q: I have a pacemaker. Is that a problem with EECP?
A: No. Pacemakers and internal defibrillators do not interfere in any way with EECP.

Q: I am on Coumadin. Is that a problem with EECP?
A: No. Patients on Coumadin are able to undergo EECP treatments safely.

Q: I have congestive heart failure (CHF). Is that a problem with EECP?
A: No. In fact, in July 2002 the FDA approved EECP as a treatment for congestive heart failure (CHF). After completing a course of EECP treatment, patients with CHF typically have less swelling in their legs, less shortness of breath, less fatigue, and often require less diuretic medication.

Q: Is there an age limit for EECP?
A: No. We have successfully treated patients as young as 36 and as old as 97 without any difficulties. Many of our patients are in their 80s and 90s and complete the entire EECP program with excellent results.

Q: I have already had bypass surgery/angioplasty/stents. Can I still have EECP?
A: Yes! Most of our patients have already had one (or many) of these procedures. They come for EECP treatment because they still have angina.

Q: Can EECP dislodge plaque and cause a stroke or heart attack?
A: 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 EECP, when your blood is flowing to your heart, it will naturally bypass arteries with plaque and enter healthy, non-diseased blood vessels to go around the blockages. Going around the blockages is a longer trip, but it is a much easier one. In time, these new pathways are reinforced and become lasting routes for blood to reach your heart beyond the blockages. Every EECP patient has had multiple, serious blockages. No one has ever had a heart attack or a stroke as a result of the treatment.

Q: Are there any patients who are not able to have EECP?
A: There are very few patients who are unable to have EECP. 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.

Q: I had a blood clot in my leg three years ago. Can I have EECP?
A: Yes. Having a history of a blood clot (deep venous thrombosis or DVT) in your leg does not preclude you from having EECP. It is recommended that you have a Doppler ultrasound of your leg to confirm the blood clot has resolved before beginning the EECP program.

Q: Does EECP aggravate high blood pressure (hypertension)?
A: No. If you have hypertension that is properly managed, you may undergo EECP without difficulty. Oftentimes, patients with hypertension find that their blood pressure improves as they proceed with EECP. If your hypertension is uncontrolled, you must seek medical care to get your blood pressure under control with proper medications before proceeding with EECP.

Q: I have bad circulation in my legs (peripheral vascular disease or PVD). May I still have EECP?
A: Yes, and you should! EECP improves blood flow throughout the entire body, including your legs. If you have poor leg circulation, you might need more than 35 treatments. My 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 EECP.


Q: I have atrial fibrillation and an irregular heartbeat. May I still have EECP?
A: Yes. An irregular heartbeat, including one caused by atrial fibrillation, will not interfere with EECP if the heart rate is controlled and no faster than 100 beats per minute.

Q: I have varicose veins. May I still have EECP?
A: Yes. Varicose veins are typically a cosmetic issue, not a medical one. As such, they do not preclude individuals from receiving EECP. We often use extra padding in patients with varicose veins to ensure maximum comfort.

Q: What happens if my angina returns months or years after I finish my EECP treatment course? Can I come back for more?
A: Yes. EECP 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 EECP as needed.

Q: Is EECP similar to chelation therapy?
A: No. There is no relationship between EECP and chelation therapy. Chelation is an invasive procedure whereby a substance called EDTA is given intravenously in an attempt to bind to calcium and remove it from atherosclerotic plaques. The fundamental problem with the concept of chelation is that atherosclerotic plaques are not only made of calcium; they include fat, cholesterol and cellular deposits as well. Chelation is a technique which has never been shown by scientific research to have any therapeutic value for heart disease. Since it has never been proven to work, chelation is not paid for by Medicare or any insurance carrier, and therefore is not accessible to most heart disease patients. Patients who choose to try it must pay out of pocket. Each treatment costs approximately $80-$100, and patients often go for numerous treatments over a period of several months, and then continue indefinitely on a maintenance regimen. Chelation can actually be harmful - even fatal - when administered to the wrong person or under the wrong circumstances. It poses particular danger to individuals with congestive heart failure. The amount of fluid administered with each treatment may overtax their weakened heart, leading to severe fluid overload and problems including pulmonary edema (a life-threatening condition in which there is an excess of fluid in the lungs).
In contrast, EECP is entirely non-invasive, proven by hundreds of published scientific studies, and safe. It is an accepted, mainstream medical treatment and, as such, is approved by Medicare and covered by insurance. Chelation does not interfere with EECP, so you may undergo both simultaneously if you choose.

Q: Is there a difference between EECP and ECP?
A: Yes. EECP and ECP are very different things. EECP is a registered trademark of Vasomedical, Inc., the leading manufacturer of EECP equipment in the U.S. Vasomedical has a patent on the timing mechanism of the machine (when the cuffs squeeze and release in time to the patient's EKG, the most critical part of the treatment). This timing mechanism distinguishes them from their competitors who make other external counterpulsation (ECP) equipment, and makes the EECP machine by far the most clinically effective device on the market. Every published U.S. study (more than 100 of them) and most studies originating in countries around the world and published in the leading English-language medical journals have used the Vasomedical EECP equipment exclusively. Accordingly, EECP - not ECP - machines are the ones found in every university hospital, major community hospital, and well-known practice that offers the treatment.

Have a question that wasn't addressed here? You can submit your question or comments through our FAQ page or emailing to, and Dr. Ajith Joy K will respond to you directly. Or, you may call us at +919633275254.