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Enhanced External Counterpulsation



Enhanced external counterpulsation (EECP) is a treatment for 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.

Cuffs, similar to blood pressure cuffs, are placed on the legs. These cuffs inflate and deflate with air to the rhythm of the heart. This helps to push blood back toward the heart, increasing blood flow. Since circulation is improved, the heart does not have to work so hard.

The Cardiovascular System

EECP pushes blood back toward the heart to reduce the heart's workload.
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure    TOP

You may have EECP to treat angina if:

  • Your medications are not working well enough
  • You are not a good candidate for surgery
  • Your doctor wants you to try a nonmedical alternative before considering surgery
  • You have had surgery but are still having chest pain

The benefits of EECP may include:

  • Decrease in symptoms of angina
  • Decreased need for angina medications
  • Ability to do activities, such as exercise, without angina
  • Improved heart function if a lack of oxygenated blood flow is a problem
  • Improved quality of life

Possible Complications    TOP

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 abnormalities

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

What to Expect    TOP

Prior to Procedure

Before you begin EECP, your doctor may:

  • Discuss your medical history
  • Discuss any medications you are taking—your doctor may not recommend EECP 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    TOP

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

Cuffs will be placed on your calves and upper and lower thighs. The cuffs attach to air hoses that will inflate and deflate them in rhythm with your heart. You will feel strong pressure from the cuffs, beginning at your calves and moving to your upper thighs. The cuffs will inflate 60-80 times each minute during the treatment.

How Long Will It Take?    TOP

You will be treated for a total of 35 hours. Treatments are usually given each day over 7 weeks.

How Much Will It Hurt?    TOP

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

Post-procedure Care    TOP

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    TOP

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 medication

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, Civelek B, 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)
Updated May 2015. Accessed June 9, 2016.
What is angina? National Heart Lung and Blood Institute website. Available at:
...(Click grey area to select URL)
Updated June 1, 2011. Accessed June 9, 2016.
What is angina? American Heart and Stroke Association website. Available at:
...(Click grey area to select URL)
Published 2015. Accessed June 9, 2016.
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 2016 by Michael J. Fucci, DO, FACC
Last Updated: 5/11/2013

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