ECP involves the inflation and deflation of 3 sets of compressive cuffs wrapped around the patient’s calves, lower thighs and upper thighs including the buttocks. During diastole, the cuffs are inflated sequentially from the calves to the upper thighs and buttocks to raise diastolic aortic pressure. Compression of the vascular beds of the legs also increases venous return.

Rapid and simultaneous deflation of the cuffs at the onset of systole produces left ventricular unloading with an associated decrease in cardiac workload. Inflation and deflation are triggered by events in the cardiac cycle via microprocessor interpreted ECG signals. This results in an increase in diastolic pressure in the arterial system which is known as Diastolic Augmentation.
  Cardiac Cycle
A.Unassisted End Diastolic Pressure
D. Reduced Systolic Pressure
B.Unassisted Systolic Pressure
E. Diastolic Augmentation
C.Unassisted Diastole
F. Assisted End Diastole Pressure

Diastolic augmentation produced by ECP greatly increases the diastolic pressure, coronary perfusion pressure and coronary circulation. It also results in increased venous return to the heart and increases the cardiac output without increasing the work upload on the heart. Diastolic augmentation produced by ECP greatly increases the pulsatile sheer stress on the intima. Recent research has uncovered a multitude of endothelial responses to sheer stress. These include the fibroblast growth factors-2 which modulate structural changes in the vessels.

ECP develops and enlarges accessory blood vessels known as collaterals (Nature’s own bypass), creating new pathways around blocked arteries in the heart, thereby increasing blood supply to the heart muscles. By causing mechanical compression on the atherosclerotic plaque through the blood colomn - much like balloon angioplasty but without puncturing the body - ECP reduces the plaque volume and also causes ‘Vascular Remodeling’ at the site of obstruction.

ECP is unique because its theoretical mode of action is on the ”Small Vessels” in the heart, which are too small to be treated by Bypass surgery or Angioplasty. Because it appears to work on a different areas of circulation, ECP may still be effective when other procedures have failed.
The acute haemodynamic effects of external counterpulsation are similar to those seen with an intra aortic balloon pump with the addition of:

• Increased diastolic perfusion pressure

• Increased coronary perfusion

• Increased coronary flow of ischemic regions of the myocardium

• Decreased left ventricular resistance

• Decreased left ventricular end diastolic pressure (LVEDP)

• Increased venous return
 


MONITOR DISPLAY OF ECP UNIT
 
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