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What is Enhanced External Counter Pulsation (EECP)?

Enhanced external counter pulsation (EECP) is a non-invasive mechanical procedure approved by the FDA to increase blood circulation to the heart to treat refractory angina and congestive heart failure symptoms. This device has inflatable cuffs that are wrapped around the lower limbs to inflate and deflate synchronously with each heartbeat so that heart can function more effectively.

Anatomy of the Heart

The heart is a fist-sized muscular organ that pumps blood throughout the body. It has 4 chambers - two upper atria and two lower ventricles. With the help of blood vessels called arteries and veins, the heart supplies oxygen and nutrients to all parts of the body and removes carbon dioxide from the body for purification. The flow of blood is made possible by the pumping action of the heart’s muscles. These muscles are supplied with oxygen-rich blood by the coronary arteries, and deoxygenated blood is removed from the muscles by coronary veins.

Indications for Enhanced External Counter Pulsation

Indications for Enhanced External Counter Pulsation include:

  • Chronic stable angina
  • Angina not responsive to medication
  • Invasive treatments ineffective or contraindicated

Contraindications for Enhanced External Counter Pulsation

Contraindications for Enhanced External Counter Pulsation include

  • Congenital heart disorder
  • Severe hypertension
  • Atrial fibrillation
  • History of deep venous thrombosis (DVT)

Preparation for Enhanced External Counter Pulsation Procedure

You need to follow the specific instructions given by your doctor or technician in preparation for the procedure. In general, you should wear snugly fitting pants such as bicycle shorts or athletic tights that don’t have seams to avoid abrasion from the cuffs. Also, diuretic medications may need to be withheld until after the procedure.

Procedure for Enhanced External Counter Pulsation

This is a non-invasive procedure that involves the following steps:

  • You will be advised to lie down on a padded table.
  • A set of cuffs will be wrapped around your calves, thighs, and buttocks.
  • Electrodes are placed on your chest and connected to an ECG machine.
  • A computer will be used to synchronize the inflation and deflation of the cuffs with your heartbeat.
  • Sequential inflation of the cuffs occurs during the resting phase of the heart pushing more blood to your heart.
  • The cuffs sequentially deflate as the heart muscle begins to contract, making it easier to pump blood.
  • The procedure can take about 60 minutes. During this procedure, you can relax by reading or sleeping. Patients are generally recommended 5 sessions a week for a period of 7 weeks.

Post-procedural care for Enhanced External Counter Pulsation

Some people may feel slight discomfort during the procedure and slight exhaustion afterward, but they will experience no pain and will recover quickly. You can return to routine activities immediately after the procedure. To ensure sustained benefits of treatment, lifestyle changes to be made include:

  • Avoiding smoking
  • Eating a healthy diet
  • Exercising regularly
  • Maintaining weight
  • Taking medicines on time

Risks and complications of Enhanced External Counter Pulsation

As this procedure is non-invasive, there are minimal risks involved. However, some patients may experience slight bruising or chafing of the skin.

Advantages of Enhanced External Counter Pulsation

  • Relief from angina that is not responsive to medical treatment
  • Increased blood flow to the heart and throughout the body
  • Improved exercise capacity
  • Decreased need for nitrates to treat angina


Signet Heart Group
2800 North Highway 75
Sherman, Texas 75090


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Practice Hours: M-F 8am – 5pm

  • American Board of Internal Medicine
  • National Board of Echocardiography
  • Certification Board of Nuclear Cardiology
  • American Board of Vascular Medicine