EECP: A non-invasive therapy that helped a heart failure patient with kidney disease bounce back

Would you believe it if you were told that the condition of a person with heart failure, not suitable
for surgery, can improve with non-invasive therapy, reduce the number of medicines taken and
improve their quality of life? If not, then the story of Brijesh Jatav*, a 61-year-old patient treated at
Medanta Heart Institute, is just one of the hundreds that will help you believe.
A long-standing patient of coronary artery disease (CAD), Brijesh has faced it all. He got an
angioplasty in 2016, when one stent was placed to widen his narrowed arteries and maintain the
blood supply. Yet, within a month, he suffered a heart attack and had to undergo an open heart
surgery. Brijesh bounced back, took his medication regularly, took all precautions and maintained a
healthy work-life balance, but developed diabetes, hypertension and chronic kidney disease (a
known risk factor in some patients). A few years later, he developed another blockage and one more
stent had to be placed in his arteries. Yet, less than a decade later, his cardiac function had dropped
to just 20%.
A weak heart is always a potentially serious condition. Twenty percent heart function or ejection
fraction is about one-third of what it should normally be. This means 80% of the blood stays in the
heart, and it is unable to pump all the oxygen-rich blood to the body. The blood that is not ejected
from the ventricle can back up into the lungs and cause shortness of breath – the most common
complaint heart patients have.
“Breathing had become difficult. My back, legs and body were in constant pain. I could barely walk. I
would not feel hungry or fall asleep. I was on a 24x7 vigil, experiencing pain and disability at all
times. I would often tell God to either show me a way or end my life,” Brijesh said.
But Brijesh and his doctors were far from giving up. During one of his visits to Medanta - Gurugram
for a regular check-up, the preventive cardiology team found fluid build-up in his lungs raising a
cardiac red flag.
“We could have operated again, but given his low heart function and high creatinine a second
arterial graft was off the table. We were already managing his condition as best as possible with
medication. He needed a non-surgical option that would improve blood flow to the heart and relieve
his symptoms. In such cases, a therapy called Enhanced External Counterpulsation (EECP) is well
suited,” said Dr Sanjay Mittal (Senior Director - Clinical and Preventive Cardiology, Heart Institute,
Medanta, Gurugram) who also heads the EECP therapy programme.
EECP therapy, or Enhanced External Counterpulsation therapy, is a non-invasive, effective and
affordable outpatient therapy approved by the U.S. Food and Drug Administration (FDA) for long-
term angina (chest pain caused by reduced flow of blood to the heart). Over the past decade, clinical
experience and numerous studies have shown that it also benefits patients who:
 Do not respond to medicines and other treatments
 Do not qualify for invasive procedures or surgeries, such as angioplasty, stenting, coronary
artery bypass surgery (CABG)
 Experience symptoms after an invasive procedure or surgery
 High-risk patients of heart failure, kidney failure, lung disease and vascular diseases
The mechanical therapy is spread over 7 weeks and completed in 35 sessions of one-hour each (no
more than five sessions a week). It involves improving blood flow to the heart by wrapping large
cuffs (like blood pressure cuffs) around both the legs and rhythmically inflating and deflating them as
the patient lies on a padded bed. Three ECG sensors are attached to the chest, legs and hips;

another sensor is attached to the finger to check for blood pressure and oxygen (SpO2) so therapy
can be adjusted for best results as per these statistics.
“The improved blood flow to the heart boosts cardiac functioning, promotes branching, i.e, creating
new peripheral arteries that naturally “bypass” clogged ones, and this relieves symptoms such as
fatigue, chest pain (angina), shortness of breath etc.
“We found EECP benefits patients when they can’t get another angioplasty, or when we cannot
place grafts or stents. Including Brijesh, at least 90% patients getting EECP at Medanta have shown
improvement,” Dr Mittal said, adding that for Brijesh as blood flow to his kidneys also improved,
excess creatinine was naturally flushed out.
Halfway through EECP therapy – started after draining his lungs of fluid and checking his lipid profile,
hba1c (average blood sugar level), renal function test, ECHO, walk test and filling a Quality of Life
questionnaire – the still-frail Brijesh chatted enthusiastically about how much more he could do
now.
“When I came here, I had nothing to look forward to. I could not walk and I was tired of life. A week
ago, my bodyache stopped. As recommended, I can now walk three times a day for as long as I can
without getting tired or breathless. I willingly do all the recommended yoga asanas in the morning
and evening, and clap my hands 500 times to improve blood flow. Last night, I slept after two
months. I woke up rested. I feel hungry again. I enjoy the recommended simple diet of peeled fruits,
milk, two rotis and lightly cooked vegetables. There’s energy to live life,” he said darting a happy
look at the doctor to ask if he could climb stairs just yet.
We will make you climb stairs, promised Dr Mittal.
True to the doctor’s word and his will, at the end of his therapy Brijesh climbed stairs holding the
railing. An analysis of his vitals showed significant improvement. Most importantly, his ejection
fraction, or heart function, had doubled.
All this was accomplished with the help of a machine that simply improves blood flow to the heart.
Every time we rue how much our body is not being able to do, medical science helps us see that
there is so much that the body can do with just a little help. It can heal itself with the right tools.
EECP is one such gift.

NOTE: The results of EECP therapy differ from patient to patient as no two patients enjoy the same
health and experience different symptoms.
(*Patient name changed to protect identity)