Do You Suffer from Chronic Chest Pain?

EECP: A New Treatment for Angina
by Howard L. Glass, D.O.
Cardiologist at Maine Centers for Healthcare

Angina pectoris refers to chest pain and/or shortness of breath associated with restriction of blood flow to the heart muscle. This restriction is usually (but not always) caused by build up of cholesterol (plaque) inside the coronary arteries leading to the heart muscle.

Muscles around these arteries constrict or narrow in response to exertion, eating, emotional distress or cigarette smoking. This constriction in an already narrowed artery can cause a complete interruption in blood flow to part of the heart muscle (myocardium). Many people experience this as chest heaviness, tightness or burning, sometimes with shortness of breath. Others experience arm discomfort, jaw discomfort and sweating. A combination of the above is common.

Relief of an "episode" of angina can be brought about simply through resting. Nitroglycerin, either a pill under the tongue or a spray under the tongue, may also provide relief. Angina occurs with an extremely variable frequency, depending on many factors in each person with Coronary Artery Disease (plaque buildup in the arteries bringing blood to the heart muscle).

Methods to relieve angina have evolved tremendously since it was first described in the 18th century. Until the middle of the 20th century, rest was the mainstay of prescribed treatment. Since then, a variety of medications have appeared, providing countless people with a better quality of life. The appearance of coronary bypass surgeries in the United States, has consistently allowed people to lead productive lives where previously impossible. In only the last two decades, we have seen the appearance and refinement of non-surgical techniques to open partially blocked arteries with catheter delivered balloons and the development of stents to keep them open.

In spite of our best efforts, there is a growing population of people who, after multiple procedures and in the face of "optimal" therapy with medication, have persistent angina. We have labeled these people as having Refractive Angina. The steady increase in numbers of people with refractory symptoms has led to efforts to develop new treatment methods.

Enhanced External Counterpulsation (EECP) is a treatment system involving the inflation and deflation of pneumatic (air-filled) cuffs, timed to the heart beat. These cuffs are applied to the legs, and synchronized to the person's electrocardiogram. This action results in improving blood flow to the coronary arteries, while at the same time decreasing the work load of the heart muscle.

A significant body of evidence has shown that EECP provides many benefits. These include decrease in episodes of chest pain, less shortness of breath and improvement in ability to exercise both for longer times and at a more vigorous level. Enhanced quality of life is the end result.

Numerous studies have shown the procedure to be both effective and safe. Not everyone who would benefit can undergo treatment and a careful screening selects people for treatment with safety considerations paramount. It has been shown to be safe for many, even for those with weakened hearts.

The usual treatment regimen is 35 one-hour sessions. These are consecutive, thus treatment lasts seven weeks. The benefits and improvements in angina, longer exercise duration and improved quality of life can be sustained for up to two years following the treatment course.

Dr. Howard Glass practices Cardiology at Maine Centers for Healthcare. MCHC is a large, multi-specialty practice located in Westbrook, Maine.


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