Download External Counter Pulsation

ECP
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ADVANCED MEDICAL SYSTEMS GROUP
Singapore | Malaysia | India | Australia
www.amssg.com
Counter
Pulsation
“A non-invasive therapy for
chronic Angina Pectoris”
DEAR PATIENT
We are writing this booklet in “non-medical” language to
help you understand how the CardiAssist™ external counter
pulsation “ECP” system may help your condition. You should
consult with your physician to determine whether you would
benefit from ECP.
JUST WHAT IS ANGINA?
Angina is a signal from your body telling you that your
heart muscle is not receiving enough oxygenated blood. Over 6
million people in the United States suffer from this condition.
The heart requires an especially enriched supply of oxygen
via the incoming blood flow in the coronary arteries. When
the vessels that supply the heart with oxygenated blood
become narrowed, the area of the heart that is not receiving
the proper blood flow responds with a very painful signal
called angina pectoris.
CIRCUMVENTING THE DAM!
Although the exact mechanism by which ECP improves
symptoms remains undefined, recent studies suggest it
PATIENT TESTIMONIAL
ynn Butler, 51, had Coronary Artery Bypass Surgery 8
years ago. However, like many diabetics, his grafts closed
back up again. Since he was not a candidate for additional surgery or angioplasty, Mr. Butler was told by his
Cardiologist to go home and take it easy. Adding to Mr. Butler’s
burden was the psychological impact of his Cardiologist’s
statement that there was nothing else that could be done. His
only option, or so he thought, was to sit at home, take his
medicine and pray he would make it through another day.
Although skeptical at first, after receiving 35 CardiAssist™
ECP treatments, Lynn is now living life again. It has been
months since he last took any nitroglycerin and he now works a
40 hour work week. Lynn is now a firm believer saying,“ I have
my life back without drugs, surgery or angioplasty, amazing.”
L
PATIENT BROCHURE
might increase the development of collateral circulation with
subsequent improvement in myocardial perfusion.1-6 We are
all born with some ability to circumvent a narrowed vessel
by opening tiny branches of other nearby vessels. This
process is called “collateral circulation.” Think of an irrigation channel and what happens if the channel is blocked.
The water naturally finds a new path around the blockage.
This is essentially what happens in “collateral circulation.”
Unfortunately, most of us are not very efficient at developing
these new networks of collateral blood flow.
HOW CAN ECP HELP RELIEVE ANGINA?
Your heart is the pump that supplies blood flow throughout the body. It supplies tissues with the oxygen and nutrients that are needed to sustain life. In order to efficiently
accomplish this important task, the heart muscle needs oxygen-enriched blood to generate energy for pumping blood to
the body. The heart relies on its own set of blood vessels
called coronary arteries to receive oxygenated blood.
ECP seems to improve circulation to your heart muscle by
opening new pathways that circumvent the blocked arteries.
Many patients see:
• less medication is required
• fewer angina attacks
• they can do much more physically such as walking,
golfing and gardening
• life becomes more “normal”
HOW WILL I FEEL DURING AND AFTER I FINISH
THE THERAPY?
Most patients describe the treatment as a vigorous massage. They also say that after you get used to it, reading or
sleeping during the treatment is very easy. Right after finishing a treatment many are energized or invigorated, but some
feel a little tired.
HOW LONG BEFORE I FEEL BETTER?
Every patient is different, but most patients start to see
improvement about half way through the 7 week cycle. Some
Cardiomedics, Inc. • 18872 Bardeen Avenue • Irvine, California 92612 • 1-888-849-0200 • www.cardiomedics.com • [email protected]
ADVANCED MEDICAL SYSTEMS GROUP
Singapore | Malaysia | India | Australia
www.amssg.com
feel a positive difference after just a week and
some require more than 7 weeks.
ARE THERE ANY NEGATIVES TO
THE THERAPY?
While most patients only require 35 sessions, some can require more. Also, the 7
week commitment can be a serious consideration for some patients. It is very important
that sessions are not missed.
WHAT ARE MY OTHER
TREATMENT OPTIONS?
PATIENT TESTIMONIAL
l Bisignano smoked 3+ packs of cigarettes a day for 30 years. He had to
have quintuple bypass in 1985 and has a history of chronic obstructive pulmonary disease. Over the past few years he found it more difficult to
breathe and had no energy for doing everyday things. He became very cautious
about participating in any activity because it would produce angina. Even walking
very short distances would give him angina and shortness of breath.
Since completing his ECP treatment 10 months ago, 73 year old Al says he is
now walking every day with no pain or shortness of breath. He also notes that he
had a new prescription filled for nitroglycerine prior to starting CardiAssist™ ECP therapy 10 months ago, but has not yet had the need to take even one pill from the bottle. Al is feeling great, is more energetic, is doing handyman chores around the
house and even better, is enjoying dancing and being able to live a normal life again.
A
Some patients may still have the option of
bypass surgery, angioplasty, drug therapy or
TMR (TransMyocardial Revascularization). You
should ask your physician which of the options best matches
your situation.
amputation or congenital deformity). There is no data to
support the use of ECP during pregnancy.
DOES ECP CARRY ANY RISKS?
JUST WHAT IS AN ECP TREATMENT?
Though rare, some patients can develop minor abrasions
from the rubbing of the cuff system. The ECP therapist or
your physician can describe any potential risk and/or complications that may occur.
ECP is a non-invasive procedure that may reduce the
symptoms of chronic angina by stimulating the formation of
small branches of blood vessels (collaterals), which circumvent the blocked arteries.
Counter pulsation occurs while the heart is resting
(diastole). It is during diastole that the CardiAssist sysWHAT ADVANTAGES DOES ECP HAVE OVER
tem actually pumps, sending blood back to the heart. Air
OTHER TREATMENTS?
is inflated into a series of cuffs placed on your calves,
ECP is less expensive, non-invasive and doesn’t require
thighs and buttocks. The system compresses your lower
recuperation after treatment. Rather than checking into a
extremities in sequence (like a wave) which increases
hospital, you visit an outpatient facility and can drive yourself
blood flow back toward your heart. The inflation of these
home when each session is completed.
cuffs is timed to your heartbeat so the
blood arrives at precisely the time the
heart relaxes. A fraction of a second
before your heart beats again, the cuffs
ohn Bartolomeo is a 55 year old teacher who had a MI in April, 1999. CPR was
are instantaneously deflated, enabling the
initiated and he was shocked more than 10 times. The doctors in the hospital
blood in your heart to be pumped (syswere pessimistic about his recovery and stated that the chances for John’s
tole), with minimal resistance. This
returning to a normal life were minimal. John did recover however, and because he
decreases the amount of work your heart
did not want any interventional procedures, he signed himself out of the hospital
must perform.
against the doctor’s orders and into the care of his own cardiologist, who recom-
PATIENT TESTIMONIAL
J
mended external counter pulsation.
John is now back teaching full time and feels he has a new “lease on life”,
thanks to CardiAssist™ ECP.
HOW DO I KNOW IF I QUALIFY FOR ECP?
Only your doctor can evaluate your condition and determine
if you are a candidate for ECP, but the general criteria are:
• You have angina symptoms
• You have had previous invasive procedures, but the
pain remains or has returned
• Nitroglycerin no longer gives you relief
• Your physician has determined that you are no longer
a candidate for any invasive procedure
Your physician should exercise his/her medical judgement when applying the CardiAssist ECP System to
patients with severe peripheral vascular disease, deep vein
thrombosis, aortic regurgitation, left ventricular hypertrophy, pacemakers, left or right bundle block, uncontrolled
arrhythmias, significant aortic valve disease, significant pulmonary disease, or unsuitable lower extremity anatomy (e.g.
IT’S AS SIMPLE AS 1,2,3...
One: ECP pumps, sending oxygenated blood
to the heart during diastole (the heart is resting)
Two: ECP stops pumping just before the
heart pumps, leaving the blood vessels open and void of
resistance.
Three: Over the treatment period your angina is reduced,
or may even be eliminated.
HOW DOES ECP TREATMENT HELP MY
HEART WORK LESS?
ECP lowers your pressure during systole (when the
heart is pumping) and increases your pressure during diastole (when the heart is resting). As a result your heart doesn’t have to work as hard to supply your body with blood
flow. A study7 has shown the accumulation of 35 hours of
treatment produces a decrease in peripheral vascular
resistance similar to the “training effect” of exercise. The
combination of improved myocardial perfusion and less
vascular resistance may explain the symptomatic improvement in patients.
Cardiomedics, Inc. • 18872 Bardeen Avenue • Irvine, California 92612 • 1-888-849-0200 • www.cardiomedics.com • [email protected]
ADVANCED MEDICAL SYSTEMS GROUP
Singapore | Malaysia | India | Australia
www.amssg.com
WHAT DOES ECP THERAPY FEEL LIKE?
ECP with the CardiAssist Counter
Pulsation System feels like a vigorous massage. After putting on your stretch tights,
electrodes are applied to your chest to provide an ECG signal so that the CardiAssist
system will be properly timed to your heart
beat. A sensor will also be clipped to your finger to give your blood pressure tracing. This
is how your therapist determines the proper
settings to maximize the effect of the therapy.
Next, the therapist places the cuff system
around your calves, thighs and buttocks.
When activated, the cuffs provide what Dr.
Kenneth Sunnnergren, Lewes, Delaware calls
“leg-hugs”. These leg-hugs™ start in a wave
form up the legs from the calves, to the
thighs and finally the buttocks.
PATIENT TESTIMONIAL
hough only 50 years of age, Akshay Patel suffered with chest pain, shortness
of breath, fatigue and the frequent need for nitroglycerine. His ability to work
was very limited due to the onset of one or all of these symptoms. He had 4
arteries that were blocked, and it was recommended that he have at least an angioplasty for symptomatic relief. However, Akshay did not want to have any invasive procedures until he had exhausted all other options, one of which turned out to be ECP.
It has now been over l year since he finished his ECP course of treatment and he
is still delighted with the fact that he can now climb stairs (even up to 7 floors) with
no shortness of breath or chest pain. He no longer needs to take one of his medications and the others have been cut in half by his physician. His use of nitroglycerine
has dropped dramatically... he has not had to take ANY since having CardiAssist™
ECP therapy! Akshay is very happy with the fact that having the ECP treatment has
eliminated the need to have any invasive procedures.
T
DO I NEED TO DO ANYTHING BEFORE
HAVING ECP THERAPY?
Once you know you qualify for ECP therapy there are a
few helpful pre-treatment do’s, don’ts and facts.
First, you must understand that you are committing to
one hour sessions, five days per week, for seven weeks.
Interruptions in the daily routine are not good and should be
avoided if at all possible. You should plan to spend about an
hour and a half each day at your treatment center.
You may feel somewhat tired at the end of the first week,
due to the “passive exercise” effect of ECP.
Each day, your therapist will conduct a pre-treatment
questionnaire, weigh you and take your blood pressure prior
to starting your therapy.
We recommend the following:
• Arrive at least 15 minutes before your scheduled time
• Wear stretch tights to reduce skin irritation
• Wear form fitting underwear, not boxers
• Wear short socks if possible
• Consume very little food or fluids before treatment
• Be sure to urinate before starting the therapy
• Take your med’s as directed by your physician
• Wear an open necked top, the looser fitting the better
• Bring music (Tape or CD player) or Books on Tape/CD
• Bring your spouse/friend if you like
CLINICAL BENEFITS
External counter pulsation has produced positive effects
in patients with coronary artery disease. These are some of
the benefits that have been observed and or published in various medical publications:
• Relief from angina symptoms
• Fewer episodes of angina
• Improved treadmill exercise times
• Nuclear stress tests show increased blood flow
• Reduction in the need for anti-anginal medications
• Improvements in lifestyle activity levels
• Ability to return to work
REFERENCES
1. Soran O, DeMarco T, Crawford L, et al. Enhanced external
counter pulsation in management of patients with
cardiovascular disease. Clinical Cardiology, 1999, 172-178
2. Zheng ZS, CY, Pan JY, Wu SX The improvement of
myocardial ischemia after intra-aortic balloon pumping.
J New Med (Chinese) 1977;6:269-271
3. Liebow AA: Situations which lead to changes in vascular
pattern. In handbook of Physiology. Circulation, sect. 2,
vol.2, chapt 37, 1251-1276
4. Kamiya A, Togawa T: Adaptive regulation of wall shear
stress flow change in the canine carotid artery. Am J
Phsiol 1989, 239:H14-H21
5. Zarins CK, Zatina MA, Giddens DP, Ku DN, Glagov S:
Shear stress regulation of artery lumen diameter in
experimental atherogenesis. J Vasc Surg 1987; 5:413-420
6. Langille BL, O’Donnell F: Reduction in arterial diameter
produced by chronic decreases in blood flow are
endothelium dependent. Science 1986; 231:405-407
7. Lawson WE, Hui J, Zheng ZS, et al, Improved exercise
tolerance following enhanced external counter pulsation:
Cardiac or peripheral effect. Cardiology 1996;87:1-5
PATIENT TESTIMONIAL
ay Picher had bypass surgery in 1980 and an angioplasty
in 1990. Despite aggressive medical therapy, even minimal activity would produce shortness of breath and pain in
his chest. At the age of 76, Ray had absolutely no energy. He
thought he was coming to the end of his life and would no longer
be able to do the things he enjoyed.
Since having CardiAssist™ ECP, Ray has had no angina or
shortness of breath. He now walks 1 1/2 miles, five times a week
and mows the lawn. Ray feels great and is very happy with how
ECP has helped him. You could say it has given Ray back his life.
R
18872 Bardeen Avenue
Irvine, California 92612
888-849-0200 • 949-863-2500 • 949-474-2446 FAX
© 2006 Cardiomedics, Inc. All Rights Reserved
L0213 Rev A 05/06
Cardiomedics, Inc. • 18872 Bardeen Avenue • Irvine, California 92612 • 1-888-849-0200 • www.cardiomedics.com • [email protected]