Enhanced External counterpulsation therapy (EECP) is a procedure performed on individuals with angina, heart failure or cardiomyopathy… in order to diminish the symptoms of ischemia, improve functional capacity … and quality of life. In various studies, EECP has been shown to relieve angina, and decrease the degree of ischemia in a cardiac stress test.

While an individual is undergoing EECP, one has pneumatic cuffs on his legs and are connected to telemetry monitors that monitor their heart rate and rhythm. The most common type in use involves three cuffs placed on each leg (on the calf, the lower thighs, and the upper thighs or buttock).

The cuffs are timed to inflate and deflate based on the individual’s electrocardiogram. The cuffs should ideally inflate at the beginning of diastole and deflate at the beginning of systole. During the inflation portion of the cycle, the calf cuffs inflate first, then the lower thigh cuffs and finally the upper thigh cuffs…. Inflation is controlled by a pressure monitor, and the cuffs are inflated to about 200 mmHg.

When timed correctly, this will decrease the afterload that the heart has to pump against, and increase the preload that fills the heart, increasing the cardiac output. In this way, EECP is similar to the intra-aortic balloon pump (IABP). Since it increases pressure in the aorta while the heart is relaxing (during diastole) EECP also increases blood flow into the coronary arteries, which also occurs during that phase.