Enhanced External Counterpulsation (EECP)

Enhanced external counterpulsation (EECP) is a non-invasive, outpatient treatment for chronic stable angina and anginal equivalents: chest pain or pressure, shortness of breath, or fatigue.

EECP is recommended for patients who may have exhausted other treatment methods, such as bypass surgery, angioplasty, arterial stents, or antianginal medications. EECP may provide benefits long after the treatment is completed, and some patients remain symptom free for years. EECP may be repeated according to symptoms and individual insurance guidelines.

EECP uses cuff-like devices on the upper and lower legs that increase the blood flow to the heart by timed squeezing with the heart cycle and rhythm. It may help the blood flow around blocked or partially blocked arteries by promoting growth of new vessels (collaterals) and also rerouting blood through nearby branches (called collateral circulation).

Click here to watch a video (1:18 min) to learn more about the procedure.

Patients wear special treatment pants provided by the staff. Diabetic patients are given specific instructions about their diet before and after treatment as well as their medications. All patients are contacted by staff prior to starting treatment.

Typically, physicians consider the following conditions to be eligible for EECP:

  • Chronic stable angina symptoms that persist while on prescribed medications.
  • Diseases or conditions that would make them poor candidates for surgery; or
  • Heart problems that persist despite previous bypass surgery or angioplasty or
  • Failed stent procedures

EECP is NOT recommended for patients with:

  • Decompensated heart failure
  • Uncontrolled blood pressure higher than 180/110
  • A heart rate higher than 100 beats per minute
  • Irregular heart rhythm that interferes with the treatment
  • Severe pulmonary hypertension (reviewed by medical director)
  • A history of current or recent DVT (blood clot in leg)
  • Severe aortic insufficiency -- a result of a weak valve; a tighter, smaller valve
  • Stents or stenosis in the leg vessels
  • Pregnancy

What to Expect
EECP is conducted in a series of 35 one-hour sessions. Patients may complete up to 2 hours, as tolerated, per day to accommodate patient schedules and needs. The patient lies on a special treatment bed. Three ECG electrodes are placed on the patient's chest and an oxygen sensor is placed on the patient's finger. EECP cuffs are placed around the patient's calves and thighs. The inflation and deflation (squeezing like a blood pressure cuff) occurs from calves to thigh according to the rate and rhythm of the patient's heartbeat. The inflation occurs while the heart is filling and getting ready to pump, lasting a second or less. Just before the heart pumps, all of the cuffs deflate at the same time.

EECP requires no recovery period. Patients may drive themselves to and from treatment. SCAT (Suffolk County Assisted Transportation) can be applied for to provide transportation for non-driving patients. Staff will assist if needed.


  • Mild headache or dizziness -- this is rare and can be a result of lowering of blood pressure during treatment.
  • Fatigue -- this may occur the first week - the muscles are receiving an hour of exercise
  • Muscle aches -- this may occur as with exercise; extra padding can be used for comfort
  • Skin irritation or bruising -- diabetic patients occasionally have lower extremity skin issues. Extra padding usually alleviates the problem. When patients are on plavix, coumadin and or aspirin, a rare patient may have some bruising. We make padding adjustments as necessary.
  • Coumadin dose adjustments may also be necessary

Watch this two-part video (each 6:30 min) to hear about the experiences that real patients have had with EECP and to learn more about the procedure.

Click here to watch Part I
Click here to watch Part II