The Big Squeeze

By Christine Gorman

If you have heart disease, you probably know all about statins and beta blockers, angioplasty and bypass surgery, and the benefits of regular exercise and a diet that's low in saturated fat. But have you heard about strapping oversize blood-pressure cuffs to your legs and buttocks and pulsing them in synch with your heartbeat? The idea behind this wacky-sounding treatment, known as enhanced external counterpulsation (EECP), is to decrease the demand on an ailing heart by helping it push blood through the body. But perhaps the oddest thing about EECP is that it works amazingly well to relieve chest pain, or angina, in many patients.

First approved by the Food and Drug Administration in 1995, EECP is most often used in folks with stable angina--the kind that often lasts five minutes or less, is brought on by physical exertion and is usually relieved by drugs like nitroglycerin. (Unstable angina tends to be severe, occurs suddenly or unexpectedly, often while a person is at rest, and requires immediate attention as it may be a sign of a heart attack.) Unfortunately, stable angina isn't always easily controlled with medications, and some people just aren't good candidates for angioplasty or surgery. That's where EECP comes in.

Patients lie down during the procedure, which lasts an hour and is performed once a day, five times a week, for seven weeks. (The cost is about $6,000, compared with as much as $60,000 for bypass surgery.) The pneumatic cuffs are timed to inflate in progression--starting with the section around the calves--when the heart reaches its resting phase between beats. As each cuff inflates, it squeezes blood out of the legs and back to the heart. "It feels like a deep muscle massage," says Dr. Debra Braverman, who administers EECP to patients in Philadelphia. The most common side effect is chafing of the skin--usually prevented by wearing elastic clothing. Folks who have very high blood pressure, valve disease, phlebitis (inflammation of a vein) or are pregnant should not undergo EECP.

Intriguingly, recent studies suggest that the heart responds to this extra flow of blood by producing tiny blood vessels to better nourish the heart. That may be why the benefits of EECP often last several years. EECP may also be useful in other hard-to-treat conditions, like congestive heart failure. "It's probably underused," says Dr. William Lawson, director of interventional cardiology at Stony Brook University Hospital in New York. That may change as the benefits of squeeze therapy become better known.