EECP Therapy - Microvascular Angina - Does it Work?

[Bruce63]

Hello there, I suffer from mild angina that affects my ability to exercise. The usual tests have come back clear and my Doctors classify it as probably Microvascular Angina/Cardiac SyndromeX. On that basis I have reaseached possible treatemenst. Enhanced External Counterpulsation (EECP) Therapy seems to be non-invasive and relatively cost-efficient. Has anybody been dealing with the same issue and/or has tried the therapy?

[Milkfairy Heart Star]

Hello Bruce63,

Welcome to the forum.

Cardiac syndrome X is a very out dated term and not usually used by a Cardiologist who truly understands the condition.

Another cause of angina without obstructed coronary arteries is coronary vasospasms, vasospastic angina.

There is no evidence to support the use of Enhanced External Counterpulsation to treat Microvascular dysfunction.

It requires daily treatments for about 7 weeks. It arduous and tiring. It tends to require repeat treatments. There is potentially a strong placebo effect.

It costs over £10,000 privately.

It is offered on the NHS at the Bradford Angina Centre, no where else in the UK. It does not have National Institute of Clinical Excellence, NICE approval.

I suggest you ask to be referred to a Cardiologist who has some expertise in caring for patients with Microvascular and vasospastic angina. This way you can have the appropriate tests to determine why you are having your symptoms.

Microvascular and vasospastic angina are very complex heart conditions. It's important to have an accurate diagnosis to ensure you have the correct treatment.

The BHF has this information about Microvascular and vasospastic angina .

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

There is also this website written by 4 patients with over 50 years combined experience of living with non obstructive coronary artery disease, NOCAD.

internationalheartspasmsall...

[JonathanH]

Hello Bruce. I am making one of my occasional visits to HealthUnlocked. I have microvascular angina and ample experience of external counterpulsation (ECP).

To start with the scientific literature, there has been a very recent publication (8 November) in the journal “Circulation” reporting on a “single centre, prospective, randomized, single blind, control clinical trial” to test the hypothesis that ECP could attenuate coronary microcirculation dysfunction (CMD) in patients diagnosed with coronary artery disease (CAD) and diabetes. The authors conclusion was that “EECP attenuates CMD in CAD with diabetes through coronary microcirculation resistance decrease”. ahajournals.org/doi/abs/10....

Previously, in 2008, Kronhaus and Lawson submitted a letter to the International Journal of Cardiology, whose abstract reads as follows: “Enhanced external counterpulsation (EECP) was used to treat 30 patients with refractory angina due to cardiac Syndrome X, with an initial improvement in CCS angina class (3.57 to 1.43; p<0.001) and regional ischemia in all treated patients. At a mean of 11.9 months follow-up, 87% of patients had sustained improvement in angina and were without MACE. EECP, by improving endothelial function, may be an effective and durable treatment for this often difficult to treat problem.” pubmed.ncbi.nlm.nih.gov/185...

I have had multiple courses of ECP treatment over the past few years. I have had multiple courses because: (1) it works for me and (2) the benefit is not sustained in me, repeat treatment being required. (I also have to repeat taking my medication!). My understanding is that the effect of ECP is variable between patients: one case was mentioned to me of a patient who, after 2 courses of treatment, was still keeping in good health after 10 years, but another individual reported on the internet zero response after 50 hours of treatment. From what I have been told, I believe that a good majority of MVA patients do benefit from ECP.

Before I had ECP, I was often horribly ill, with debilitating symptoms and numerous trips/admissons to hospital, including blue light ambulance journeys. I remember on one occasion feeling progressively more ill as I went shopping in a local supermarket, until I doubted that I could manage to get the shopping back to my car. I sat on a step, called my wife for help and would have burst into tears if not in public. Ever since my 2nd ECP course took effect, I have never been anything like so ill and have been adequately functional to carry out my daily activities, including hilly dog walking here in Wensleydale. I also exercise daily on an exercise bike with the aid of a chest strap ECG to monormal nitor my ECG for indications of ischemia (ST-depression, T-wave flattening) so that I can avoid over-exercising. I can therefore tell you that I can see the benefits of ECP in my ECG waveform.

I would describe ECP as life-transforming. Nonetheless, both MVA and ECP are unpredictable physical and emotional roller coasters. My first ECP course delightfully made me feel so much better within a short time after the treatment but subsequent courses have disappointingly tended to make me feel worse before better. Whatever its shortcomings, the drugs I have tried haven’t been a patch on ECP.

A standard course of ECP is 35 (or 36) hours, with one or two hours of treatment a day. More recently, I have for logistic reasons undertaken 3 hours a day. I sometimes have a full course and sometimes a top-up course (conventionally 20 hours). The machine requires a break after each hour of treatment. The treatment does not in my experience involve unpleasant discomfort, except on rare occasions when action can be taken to reduce this. In fact, I am often able to sleep during the treatment. I would never describe the treatment as “arduous” although I tend to find it tiring, especially for some reason afternoon sessions. I believe that more elderly patients, in particular, can find the treatment more demanding than I do.

I have been told that patients who have fragile skin because of advanced age and/or diabetes have a more difficult time with ECP. I am approaching 64 and non-diabetic, and can get through an ECP course without so much as a skin lesion.

Milkfairy is correct that private ECP is expensive and, unless you live in Bradford, is going to be exceptionally difficult to obtain on the NHS.

Can I help further?