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What is Coronary Artery?

Coronary artery is a general term used to define the arteries, which are surrounding the heart and supplying blood to the heart muscle. Coronary arteries are the first branches of the aorta originating from the heart and are mainly composed of the right and the left coronary arteries.Left main coronary artery is composed of two branches covering the anterior and posterior of the heart. Therefore, there are three main coronary artery systems.

What is Collateral Circulation?

There are several small sized vessels located between the coronary arteries. This system, which is also defined as the collateral circulation, is responsible for carrying adequate amount of blood to the coronary artery tissues. In some cases, minor vessels develop to supply blood from the healthy arteries to the tissues failing to receive blood. This network of minor vessels is called collateral circulation. Development of the collateral network is biologically a slow process. Cardiac patients do not have time to wait for the development of the collateral network and collateral network does not develop at the adequate level in these patients without an extra support.

What is Angina Pectoris?

Angina pectoris, whichis also named as chest pain, is the most common sign of coronary artery disease. Majority of the patients with angina pectoris suffer from severe chest pain as a result of physical and mental stress. Symptoms associated with this problem are generally shortness of breath, indigestion, dizziness, fatigue and pain in the chest, arms, neck and jaw.

What is Heart Failure?

Contrary to the general understanding, heart failure is a syndrome but not a disease. In this syndrome, adequate amount of blood cannot be supplied to the tissues or the pressure is not adequate as a result of an abnormality in the heart function. Patients with this syndrome develop shortness of breath and swelling on the ankles. The patient can no longer live a normal life.

What is EECP?

EECP, which has widely been used in coronary artery disease and heart failure treatment in the United States and has recently started to be used in our country, is very comfortable for the patient. It is an advantageous and long-lasting treatment modality without any risk to the patient and does not require any intervention and hospitalization.

Coronary artery diseases are among the top most common causes of mortality worldwide.EECP treatment plays a major role in preventing fatal events occurring during this process such as heart attack, heart failure and resulting death. 

EECP treatment is based on the principle of enlarging the coronary arteries and their tiny branches and developing collateral circulation network between these branches. Ultimately, blood supply to the heart is regulated in patients with vascular occlusion or stenosis and symptoms such as chest pain, fatigue, shortness of breath or palpitation are prevented. Furthermore, heart attack risk is reduced and quality of life of the patient is significantly improved.

According to the results of the studies, efficacy of EECP treatment is proven to last up to 5 years in 88% of the patients. Patients can get back to their normal activity after this treatment, which lasts for 1 hour a day for a period of 35 days.

EECP treatment was approved by FDAfor the treatment of heart failure, stable angina, unstableangina, cardiogenic shock, acute myocardial infection. Machine used in EECP treatment has CE certificate, ISO certificate and other relevant certifications.

How is EECP treatment applied?

EECP treatment is applied 1-hour daily for 5-6 days a week for a period of 35 days. It is a painless treatment. It is also a safe and reliable treatment modality as there is no risk for the patient. There is no interventional procedure or any injection and the patients can be treated while reading books or listening to music.

How does the EECP machine work and what is the objective of treatment?

Components of the EECP machine are treatment table, control console, air compressor and 3 cuff sets. The cuffs are wrapped around the lower leg, upper leg and hips of the patient. The patient is connected to the ECG during the treatment. Systolic and diastolic blood pressure of the patient is monitored with the use of finger pleythysmogram. During the diastole, the cuffs inflate with air. This helps to increase blood flow to the heart and to supply blood to the heart muscles. During the systole, the cuffs deflate and the workload of the heart is reduced. The vessel walls are subject to more chronic pressure with increased blood flow at the coronary arteries and this results in enlargement of the capillary vessels due to the pressure difference in the vascular bed and thus the collateral circulation system allows blood supply in a healthier way to the regions failing to be properly fed in the heart.

How Does Eecp Work?

A healthy heart is only functional once there is a balance between oxygen consumption and oxygen supply. Oxygen consumption is associated with heart rate and pumping. Whereas, oxygen supply is associated with blood flow. In this process, 80% of the blood reaching to the heart muscle occurs during the relaxation phase of the heart. EECP treatment allows for a natural by-pass and blood is supplied to the heart muscle by way of forming new vessels.

Whıch Patıents Are Elıgıble?

Patients eligible for EECP treatment are those:

  • developing restenosis following previous by-pass surgery or wire/stent treatment,
  • with persistent complaints despite of being treated with other options,
  • with inappropriate vascular structure for surgical intervention,
  • at high risk for surgery,
  • refusing to be treated with balloon, stent or surgery,
  • with heart failure.

Patients ineligible for EECP treatment are those:

  • underwent by-pass surgery in the last 3 months,
  • having risk of clotting,
  • with unhealed wound on legs,
  • with severe aortic regurgitation,
  • with uncontrolled hypertension,
  • pregnant or having suspicion of pregnancy.

What Are The Benefıts Of Eecp Treatment?

EECP treatment provides for a very comfortable process for the patient and it also has several direct and indirect benefits for the cardiac health such as:

  • It increases blood flow to the heart.
  • It helps to supply more oxygen to the heart during the relaxation phase.
  • As the blood on the legs are pumped through the heart, the blood filling the heart also supplies blood to the vital organs such as kidneys and the brain, without any extra burden on the heart.
  • Workload of the heart is reduced and its performance is improved.
  • It helps for the development of new blood vessel network around the damaged or occluded blood vessels.
  • It reduces or totally prevents chest pain.
  • It decreases lactic acid production and thus prevents muscle fatigue.
  • It strengthens heart muscle and supplies oxygenated blood to the heart in patients with heart failure.
  • It reduced risk of heart attack.
  • It improves quality of life of the patients.
  • Efficacy of the treatment continues even years after treatment.

What Are The Improvements Observed After Eecp Treatment?

The patients can walk longer distances after EECP treatment. They can also carry heavier packages and have a more active life without suffering from chest pain. Furthermore, patients who are able to return to work require less antianginal medication. They can exercise without chest pain and join social activities.

Are There Advantageous Of Eecp Over Other Treatment Optıons Of Value?

  • Not having a vital risk for the patient, as long as indications and counter-indications are strictly followed.
  • Ease of application.
  • Not using disposable materials during the treatment.
  • Not having any risk for the patient in parallel to factors such as materials and equipment.
  • Not requiring hospital stay.
  • Being an outpatient treatment and thus not resulting in loss of labor and time.
  • Resulting in objective and subjective improvement, when invasive revascularization techniques fail.

Is There Any Sıde Effect Of Eecp Treatment?

There is no reported severe side effect of EECP treatment. However, there may occur minimal level of skin irritation around the cuff site due to pressure.

Can Eecp Treatment Elımınate The Need For By- Pass Surgery?


EECP is the most favorable and comfortable treatment method for patients ineligible for surgery or refusing surgery.

EECP is a comfortable treatment option, which is an outpatient treatment unlike both by-pass surgery and balloon angioplasty and does not pose any risk. Patients with severe form of the disease or those with left main coronary artery disease may require by- pass surgery.

For How Long Eecp Treatment Has Been In Use?

EECP treatment has been developed following a long research and several studies. The reason why this treatment with 50-year of history is defined as new is that it started to be in routine clinical use in 1995. EECP, which was approved by FDA in 1995 and later started to be used widely in treatment of coronary artery disease and heart failure, is a non-invasive and non-traumatic treatment method used inclinical routine.

Where Is Eecp Treatment Applıed?

EECP is applied in over 2000 health care institutions in the United States and in several countries including universities such as Yale University, Harvard University, Pittsburgh University, Kyoto University, Milano University, Hammersmith Hospital, Mayo Clinic, Johns Hopkins Medicine and Centre de Medicine Preventive Cardio-Vasculaire, which are the worldwide leading institutions conducting high-quality studies and contributing to the new developments in the field of science and medicine. It is an inevitable method of choice in treatment of heart failure and heart diseases.

Is It Possıble To Repeat The Eecp Treatment?

Rate of repeating EECP treatment, which has been applied based on technological developments and scientific studies with successful outcomes, is 9% in the long termfor severe patients. Furthermore, as the method has no risk, it may also be applied in heart failure patients and candidates for heart transplantation.

Can Dıagnıstıc Tools Show The Benefıts Of Eecp Treatment?

Impact of EECP treatment on cardiac health can be measured by some tests and investigations. Blood supply to the heart tissue can be observed particularly with exercise test, Thallium scintigraphy and GatedSPECT.

What Is The Sıtuatıon Of Heart Dıseases In Our Country?

Heart diseases rank the top among causes of death worldwide. In addition to this, healthcare expenditures for treatment of heart diseases rank the top among all other diseases. Besides, number of symptomatic coronary artery disease and heart failure patients increases every day. Every year there are 160.000 new cases of cardiac patients, as 2000 of those being heart failure patients and almost 30.000 patients die as a result of sudden death.Decreasing this number is closely associated with paying more attention to cardiac health of the society, adopting a life-style that protects cardiac health and raising awareness in the society.

Is Eecp Treatment Applıed In Our Country?

EECP treatment is applied in 9 centers in Turkey. EECP, which is particularly applied for patients with chronic renal or respiratory failure and diabetes, is a reliable treatment method with low cost.

Wıll Eecp Brıng Extra Burden On Healthcare Expendıtures Of The State?

Studies conducted have demonstrated that EECP is cost-effective particularly in treatment of symptomatic coronary artery disease and heart failure, when compared to other treatment methods. It costs cheaper than the other treatment methods as the treatment does not require hospital stay, the patients are treated in the outpatient clinic and disposable materials are not used.

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