Using TMC's IECP Device ?Information you may want to know

How Can Interventional Cardiologist’s Best Utilise IECP ‘Increased External Counterpulsation?

Introduction

Is there a way in which Interventional Cardiologists utilise IECP 'Increase External Counter-pulsation' along with their catheterisation procedures? Since its beginning External Counter-pulsation had been a modality of dislike for most of the interventional cardiologists and cardiovascular surgeons, despite its apparent potential benefits. There are several possible reasons, but we are not going to discuss the same in this topic. But there is a broad range of patients which an interventional cardiologist or a cardiac surgery centre/ hospital comes across, which are suitable for IECP 'Increased External Counter-pulsation'.

IECP 'Increased External Counter-pulsation' can be very successfully and wisely be administered in following two ways, to suitable patients.

CARDIAC REHABILITATION - As a second line treatment for those patients who have already undergone Angioplasty or CABG, by means of cardiac rehabilitation.

NO OPTION PATIENTS - As a first line treatment for those patients who are not suitable for any further revascularisation procedures like angioplasty or bypass.

Now we will discuss how IECP can be best implemented in above two ways at an interventional / cardiothorasic centre without effecting their specialisation i.e. stenting, surgery etc.

CARDIAC REHABILITATION

Cardiac rehabilitation is now becoming popular and you find a lot of centers offering this protocol for people who have undergone bypass surgery, angioplasty or other cardiac interventional / surgical procedures to give a good life to a heart patient. Doctors find a lot of patients who after undergoing surgical procedures are not able to get back to their normal life. By means of cardiac rehab including external Counter-pulsation a doctor can bring a patient into fell well and normal life again. As a worldwide protocol cardiac rehab is provided in four phases and it is mostly recommended to use IECP 'Increased External Counter-pulsation' in the third or fourth phase. We are going to have a brief overview of the four phases of cardiac rehabilitation below. This information is for reference only and should not be considered as a medical advice.

PHASE - I

Phase one begins early after a cardiac event, while the patient is still in the hospital. This phase usually includes light exercise such as walking the halls and stair climbing under supervision.

PHASE - II

Phase two is started after discharge. It remains OPD counselling in which the patient is educated on how to return to normal active life. The main goal is to provide education for lifestyle changes to improve functional capacity and endurance of the patient and reduce his fear and anxiety about increased activity.

PHASE - III

Phase three is a continuation of the Phase II program, in which along with the education program monitoring of heart rhythm, rate and blood pressure before, during and after exercise is done. A physician may refer you for an IECP 'Increased External Counter-pulsation' during this Phase.

PHASE - IV

Phase four includes training on regular unsupervised exercise program. IECP 'Increased External Counter-pulsation' is best to administer in this phase on an outpatient basis. The patient can attend the IECP treatment 5 to 6 times in a week for six weeks and it will bring a dramatic change in lifestyle of a patient.

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NO OPTION PATIENTS

On an average –% of people are not suitable for any operative or interventional procedures due to many reasons which may include bleeding disorders, uncontrolled hypertension, peripheral vascular disease, endocarditis, morbidity etc. These kinds of cases are considered as no option patients and are considered suitable only for IECP. IECP provides symptomatic benefit in a broad range of clinical states. It is particularly useful in patients with severe, limiting symptoms of ischemic coronary disease despite an optimal medical regimen and for whom standard revascularisation is not an option. Safety and efficacy in other disease states, including vasospastic angina, endothelial dysfunction, and heart failure, are under investigation. IECP therapy is indicated for use in stable and unstable angina pectoris, congestive heart failure, acute myocardial infarction, and cardiogenic shock.

Patients that may benefit from IECP Therapy
Patients with angina or angina equivalents who:
No longer respond to medical therapy.
Restrict their activities to avoid angina symptoms.
Are unwilling to undergo any additional invasive revascularisation procedures.
Have LVD (EF <35%).
Have co-morbid conditions that increase the risk of revascularisation procedures (e.g., diabetes, heart failure, pulmonary disease, renal dysfunction).
Have coronary anatomy unsuitable for surgical or catheter-based revascularisation.
Are considered inoperable or at high risk of operative/interventional complications.
Suffer with microvascular angina (Cardiac Syndrome X).
Heart failure patients in a euvolemic state with:
Ischemic or idiopathic cardiomyopathy.
LVD (EF <35%)
Co-morbid conditions that increase the risk of complications of revascularisation procedures.

The IECP 'Increased External Counter-pulsation' can be safely and effectively administered in above cases and does not act as a competition to surgical procedures. Any interventional cardiologist or cardiac surgeon can incorporate IECP in his clinic or hospital, without treating it as an alternative therapy to bypass or angioplasty. Both the modalities have different creed of people to cater and by having both options available a cardiac hospital can turn out to be complete cardiac care centre to take care of all types of heart patients.

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