ECP stands for external counter pulsation, a non-invasive, low risk procedure that can reduce or eliminate the symptoms caused by coronary artery blockage. ECP recruits and enlarges accessory blood vessels known as collaterals (Nature’s own bypass channel) , creating new pathways around blocked arteries in heart there by increasing blood flow to the atherosclerotic plaque through the blood columns, much like balloon angioplasty (but without puncturing the body). ECP reduces the plaque volume and also causes “Vascular remodeling “ at the site of obstruction today’s patients are better educated about their disease.

So can ECP absolutely prevent a heart attack from happening? The answer is no. the blockages that you had before ECP will still be there and they will still be susceptible to having blood clots form in them or to have the natural sludging process continue slowly. If your ECP treatments have been effective though, as evidenced by an increased exercise toleration and reduced angina frequency, then you can be assured that the extra collateral circulation or “natural bypasses” that have been grown for you will at least minimize the size of any heart attack that you might have if a blood clot should lodge in a partially blocked artery as is the case in about 85% of those heart attacks that occur. That is they occur as a consequence of a blood clot. Adequate to avoid any angina or even a small heart attack, if that 80% blockage becomes 100%, as a result of a blood clot or the progressive slow blockage from cholesterol.

Perhaps an appropriate analogy might be as follows. If a family’s house was burning and the fire department was called and was able to save three of the five family members but that two people in spite of their best efforts perished, would the remaining family thank the fire fighters for saving the three or complain bitterly about why they could not save other two. this is essentially the same dynamic that occurs with ECP. In spite of a heart attack that might have occurred, how much heart muscle was nevertheless saved as a consequence of the effective growth of some of these “natural bypasses,” that like the firefighters would attempt to put as much of the fire of coronary disease as possible.

If you don’t control the risk factors that caused the blockages to occur in the first place then the gradual sludging of your arteries will eventually overwhelm any benefits from ECP and your angina may return or become worse.

As we have discussed before these risk factors include 1) High blood pressure 2) smoking 3) no exercise 4) High stress life style 5) diabetes 6) Elevated cholesterol 7)Elevated Homocysteine, Fibrinogen, Lipoprotein (a) or C-Reactive protein in your blood. Each of these problems can be treated but you don’t know to treat them unless you are aware that it is a problem for you. So please make sure that you know the results of these tests.

The noninvasive “Total Attack” approach that is recommended then includes ECP to grow new circulation to compensate for any blockages that might be already present, but also include an aggressive approach to the risk factors that caused the blockages to occur in the first place. Angioplasties, stents and bypass surgery can then be reserved for those patients that are felt to be too unstable to wait the necessary 7 weeks to complete a courser of ECP and to begin the risk factor modification program.

If after a first course of ECP a patient is significantly improved, on the basis of frequency and severity of angina symptoms, as well as improvement on an exercise test, but is still having some angina symptoms or has not normalized his exercise test, then additional time with ECP will be recommended.

The understanding will be that if ECP has gotten rid of 50% or more of a patient’s symptoms but that some symptoms still persist, then let’s stick with what seems to be working and try to get rid of even more angina and perhaps continue to reduce some of the medications necessary to control it.