Enhanced External Counterpulsation



Enhanced external counterpulsation (EECP) is a treatment for the heart. It uses inflated cuffs on the legs to help push blood back to the heart. It improves circulation and decreases the workload of the heart.

chronic, stable chest pain known as angina. Angina happens when there is not enough blood and oxygen being pumped to the heart to support the work it is doing. EECP may also be used to treat certain people with heart failure.

The Cardiovascular System

EECP pushes blood back toward the heart to reduce the heart's workload.
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Reasons for Procedure

EECP is used to treat angina. Angina is chest pain caused by poor blood flow to the heart muscle. EECP can increase the amount of blood going to the heart which can relieve the pain. You may have EECP to treat angina if:

  • Medicine is not working well enough
  • You are not a good candidate for surgery
  • You have had surgery but are still having chest pain

EECP may lead to:

  • Decrease in symptoms of angina
  • Decreased need for angina medicine
  • Increase ability to do activities, such as exercise, without angina
  • Improvement in the heart's ability to work
  • Improved quality of life

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Chafing
  • Bruising or blisters
  • Bleeding if your blood is too thin
  • Leg or waist pain
  • Worsening of heart failure in people who have certain heart rhythm problems

You should not have EECP if you are pregnant or have any of these conditions:

What to Expect

Prior to Procedure

Before you begin EECP, your doctor may:

  • Ask about any medicine you are taking—EECP may not be an option if you take blood thinners
  • Answer any questions you have about the procedure

You may want to wear tight-fitting, seamless pants. This can help prevent chafing from the cuffs.


You will not be given any anesthesia. EECP is not painful.

Description of Procedure

You will lie on a padded table. Electrodes will be placed on your chest to watch your heart rhythm. Your blood pressure will also be checked often.

Cuffs will be placed on your calves and thighs. The cuffs attach to air hoses. They will inflate and deflate the cuffs in rhythm with your heart. You will feel strong pressure from the cuffs. The cuffs will inflate 60 to 80 times each minute during the treatment.

How Long Will It Take?

You will be treated for a total of 35 hours, spread out over 7 weeks.

How Much Will It Hurt?

EECP is not painful. You may feel uncomfortable when the cuffs tighten on your legs.

Post-procedure Care

After your treatment, the electrodes and cuffs will be removed. You can go home as soon as you are done with treatment. You may feel slightly tired after the treatment. This feeling will get better over time.

When you return home, do the following to help manage your angina:

  • If you smoke, talk with your doctor about how you can quit.
  • Manage your weight.
  • Eat a healthy diet.
  • Drink plenty of fluids throughout the day.
  • Exercise regularly and stay as active as possible.
  • Go to any recommended appointments.
  • Follow your doctor's instructions.

Call Your Doctor

After arriving home, call your doctor or call for medical help right away if there are signs that your angina is getting worse:

  • Severe chest pain that may feel tight or heavy
  • Shortness of breath
  • Numbness or tingling in shoulder, arm, or wrist
  • Nausea
  • Symptoms not relieved with medicine

If you think you have an emergency, call for emergency medical services right away.


American Heart Association
National Heart Lung and Blood Institute


Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada


Amin F, Al Hajeri A, et al. Enhanced external counterpulsation for chronic angina pectoris. Cochrane Database of Systematic Reviews. 2010;2:CD007219.
Enhanced external counterpulsation. Cleveland Clinic website. Available at:
...(Click grey area to select URL)
Accessed June 20, 2018.
What is angina? National Heart Lung and Blood Institute website. Available at:
...(Click grey area to select URL)
Updated June 1, 2011. Accessed June 20, 2018.
What is angina? American Heart and Stroke Association website. Available at:
...(Click grey area to select URL)
Published 2015. Accessed June 20, 2018.
Manchanda A, Soran O. Enhanced external counterpulsation and future directions: step beyond medical management for patients with angina and heart failure. J Am Coll Cardiol. 2007;50(16):1523-1531.
Last reviewed June 2018 by Michael J. Fucci, DO, FACC
Last Updated: 9/16/2020

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