Enhanced external counterpulsation (EECP)
Chest pain, or angina, occurs when the heart does not receive enough oxygen. Angina symptoms can vary from person to person. Chest pressure and chest fullness are the most common examples of angina. Sometimes it may feel like shortness of breath or indigestion and on occasion it may be even fatigue. The cause of angina is always the same: poor blood to the heart muscle, no matter what the symptoms are. Once the artery has become blocked, there are several traditional approaches available to treat coronary disease, including medication, angioplasty, stents and coronary artery bypass surgery. For patients who are not candidates for those traditional treatments, or for whom traditional treatments have not relieved angina, there is another option.
A non-invasive treatment called enhanced external counterpulsation (EECP) is a safe and effective way to improve blood flow to the heart muscle, minimizing angina, possibly decreasing the need for heart medication, and improving the patient’s quality of life. EECP increases blood flow to the heart muscle that is not receiving enough blood and oxygen by helping form new small blood vessels. Known as collaterals, these blood vessels naturally bypass the blocked arteries.
The EECP treatment regimens are one hour a day, five days a week for a total of 35 treatment hours. Patients lay on a treatment table with cuffs wrapped around their calves, thighs and buttocks. Three electrodes are placed on the chest; the system uses an ECG signal to synchronize inflation and deflation of the cuffs. Patients experience a sensation of a strong “hug” moving upwards from the calves to the thighs and to the buttocks during inflation followed by a rapid release of pressure on deflation. EECP treatments are relatively comfortable. To help patients relax, they can watch TV, listen to music or sometimes patients may even sleep.
Enhanced external counterpulsation is available at Community Heart and Vascular East. If you would like more information about EECP, please call the clinic at 317-355-1234.
Transradial approach to coronary diagnostic procedures
Cardiac catheterization diagnostic procedures are traditionally performed by placing catheters through the artery in the groin area. This type of procedure necessitates a period of approximately six hours of bed rest after the catheters have been removed and the bleeding stopped.
For patients who find it very difficult to lay on their back in bed for lengthy periods of time, or who have disease in the arteries of the lower body, the transradial approach to cardiac catherterization offers an alternative method that can eliminate the post-procedure bed rest.
Instead of utilizing the artery in the groin area, the artery in the wrist (radial artery) is used to insert the catheters. After the procedure is completed, the catheters are immediately removed and a pressure dressing is applied to the wrist after the bleeding is controlled. The patient is then able to get up from the procedure table immediately.
Not all patients are candidates for this type of procedure. Certain requirements regarding circulation to the hand and certain types and locations of coronary artery disease are unable to be treated using this approach.
Minimally-invasive cardiovascular procedures
Coronary bypass surgery is a common procedure used to treat patients experiencing blocked coronary arteries. Traditionally, the procedure has involved cutting open the breast bone and placing the surgery patient on a heart/lung bypass machine during surgery. Community Heart and Vascular offers two procedures that are significantly less invasive than traditional surgery. For many patients, these procedures can mean shorter, less expensive hospital stays and easier and quicker recovery periods.
Minimally-invasive direct coronary artery bypass (MIDCAB)
Involving just a small incision about three inches long on the side of the chest, this procedure attaches the internal mammary artery, which runs along the chest wall, to the area below the blockage in an artery.
Fresh blood supply to the heart is restored and the patient’s heart continues to beat during the surgery unlike in traditional bypass surgery where the heart is stopped and the patient is placed on a heart/lung machine during surgery.
Although only a small percentage of all patients needing bypass surgery qualify for the MIDCAB procedure, it offers distinct advantages to certain patients.
For patients who need one or two bypass grafts on the front side of the heart, MIDCAB can mean a shortened hospital stay. These patients usually return to a normal, active lifestyle within two weeks, as opposed to a week-long hospital stay and several weeks of recovery for traditional bypass patients.
We also have available the newest technology and extensive experience with beating heart bypass surgery, which avoids the heart/lung machine and its side effects. Both of these procedures allow us to offer alternatives, especially to high-risk patients who might otherwise not be a candidate for the traditional bypass surgery.
For high-risk patients who are not candidates for traditional bypass surgery because of a medical condition, MIDCAB offers an alternative.
MIDCAB’s chief benefit is that it is far less stressful to the body than traditional bypass surgery. Because patients’ hearts are not stopped during surgery, they suffer none of the common recovery difficulties faced by people who have been placed on a heart/lung bypass machine.
Additionally, patients may appreciate that the surgery requires no blood transfusions, involves a much smaller incision and involves less anesthesia during surgery and less pain after surgery.
Endoscopic saphenous vein harvesting
To perform a coronary artery bypass, the surgeon often must take or “harvest” portions of a large vein in one or both legs known as the saphenous vein. This vein is what the surgeon uses to bypass any blockage in the coronary artery.
When the grafted vein is placed between the aorta and a point in the artery beyond the blockage, the bypass is complete.
Traditionally, the bypass required making a large incision in one or both of the patient's legs. These incisions at times can run the entire length of the leg and are responsible for much of the pain associated with coronary bypass surgery.
With endoscopic saphenous vein harvesting, the trauma associated with vein harvesting is significantly reduced. In this procedure, the surgeon removes the saphenous vein through one to three small incisions in the leg.
A tiny video camera helps the surgeon visualize the removal of the vein without requiring a long incision across sensitive muscle tissue. Of course, smaller incisions often mean less pain and a faster recovery period for the patient.
Many patients can experience the benefits of this method of vein harvesting since a large percentage of all coronary bypass patients are candidates for this procedure.