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Pressure therapy eases chest pain for cardiac patients

| Monday, March 10, 2008

Harry Baldwin says he feels like a new person.

Gone are the days of sitting in a wheelchair with oxygen tanks by his side. He still has coronary heart disease, but now Baldwin walks every day, and he's lost more than 50 pounds.

He owes his new outlook on life to getting his legs squeezed.

In August, Baldwin began seven weeks of a therapy called external counterpulsation, or ECP. For an hour a day he lay on a bed while inflatable cuffs methodically squeezed his legs to push blood into his heart.

"I was in pain all the time in my chest," said Baldwin, 62, who has a history of cardiac problems.

Over the years he has undergone four cardiac bypass surgeries, and stents have been installed to prop open his arteries.

Baldwin, of Greensburg, also suffers from diabetes and chronic obstructive pulmonary disease, or COPD.

"I didn't do much moving around before," he said, but ECP "got me motivated."

"I was always in pain. I don't have that any more," Baldwin said.

Blocked up

Those chest pains, called angina pectoris, arise when the heart is not getting enough blood and oxygen to work effectively. The pains typically occur when one or more of the heart's blood vessels are narrowed or blocked.

"ECP is a non-invasive treatment for people with angina," explained cardiologist Stephen Bowser, whose Century Cardiac Care office is affiliated with Mon Valley Hospital.

The treatment helps to push blood to the heart, which improves circulation and allows the organ to work better.

It's an option for patients with coronary disease whose treatment choices are limited.

"They're not a candidate for angioplasty or vascular surgery," said Bowser. "It's usually people that we've already done a (heart) catheterization on, and they have blockages we can't fix. If we can't control their symptoms with medication, they are ideal for ECP."

The one-hour treatment is administered daily, Monday through Friday, for a total of 35 days.

The ECP machine consists of a large bed equipped with a compressor and six hoses that attach to the half-dozen cuffs, three for each leg.

"They are like giant blood pressure cuffs," said Vicki Seel, a certified ECP therapist at Excela Health's cardiac rehabilitation clinic at Westmoreland Hospital. "It inflates the cuffs from calf to thigh to buttocks. Then they deflate. Then it does it again."

This systematic inflation pushes the blood from the extremities to the heart muscle.

The process is closely monitored to ensure that enough blood reaches the heart between beats. During treatments the patient wears three leads to an electrocardiogram, which records the heart's rhythm and rate as the cuffs squeeze and release. If needed, a therapist can adjust the cuffs' timing.

"When the cuffs deflate, that's when the heart pumps the blood into the body," said Seel. "We're getting the blood into the heart when the heart is resting. So then when the heart pumps, it gets more blood to the lungs and picks up more oxygen."

Seel compares the process to an automobile engine: If it is not timed properly, the engine will sputter and choke.

A mechanic can adjust the engine's timing so the vehicle runs without a hitch. Seel is the "mechanic" who adjusts the timing of the blood flow to help the heart run smoothly.

In addition to reducing chest pain, that may allow patients to exercise more easily and generally feel more energetic.


Although doctors insist the therapy is not painful, Baldwin quickly admits it was not the most comfortable experience of his life.

"It's like someone is laying you on the floor and kicking you," he said. "It's not a pleasant thing. (But) it does what it is supposed to do. I'm just glad to be rid of those (chest) pains."

Although Seel does not have heart problems, she did try the machine so she could tell her patients what to expect.

Some patients have side effects such as a mild headache, dizziness or muscle aches. A small number report skin irritation, pressure sores or bruising from the cuffs.

"It's tight pressure," Seel said. "It is continuous for the session. I have patients who get so used to it they can sleep through the procedure."

Patients can watch television in the room or even read during ECP the session.

"I don't know how they read while the machine is operating," said Seel with a laugh.

Bowser said science can't fully explain why the therapy works, but "we know people feel better" afterward.

In fact, the therapy's success is measured by how the patient feels.

So Seel asks questions: Do you still feel chest pain• Are you short of breath• Can you walk up a flight of stairs without feeling winded?

"In this particular treatment, unlike a surgical procedure, there's no visible improvement," said Seel. "Nothing the patient can see."

In addition to improving overall circulation, ECP can help a patient develop tiny blood vessels surrounding the heart called collateral arteries. This collateral growth improves blood flow and helps to get more blood to the heart.

After the ECP therapy, the patient is sent back to his doctor for further testing. The doctor usually does an echocardiogram -- an ultrasound procedure that produces a moving image of the heart -- to see if the heart muscle is working efficiently.

If necessary, some patients will be prescribed a two-week "maintenance therapy" session six months after the first round of ECP is done.

"That helps to keep everything on an even keel," said Seel.

Baldwin will be starting a two-week maintenance session in a few weeks, and he's looking forward to the result.

"I can't wait to go back and do it again next month," he said.

"I haven't felt this way in 20 years. I feel like a brand new person."

What is ECP?

Heart patients with angina, or chest pain, may be candidates for a non-invasive therapy called external counterpulsation. During an ECP session, pressure cuffs on the legs are inflated in a carefully timed sequence. This gently compresses the blood vessels in the legs, forcing the blood back to the heart.

ECP therapy:

• Lowers the pressure the heart must pump against.

• Increases the rate of return of blood to the heart.

• Increases blood pressure while the heart is resting.

The result may be fewer episodes of angina and an increased ability to exercise.

Source: American Heart Association

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