vstefans Asked June 2011
Will it help my mother to put her through Enhanced External Counterpulsation for her angina?
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She has bad, inoperable coronoary artery diseae and has a lot of angina. None x 2-3 nights on a higher dose of Ranexa. Often she just gets anxious adn says "help me help me" or somethign equally vague when having chest pain, so she does not alwys get short acting nitro when she should. Her mobility is poor and she can't lie flat. The treatments would be outpatient involving travel that she can tolerate OK, about an hour each treatment, and they can put the head of the bed up at least 45 degrees, 5 days a week for seven weeks. Its not a cure but might let her live with less pain at the very least if it works for her. Any experiences with this appreciated!
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Thank you for all your input on these discussion boards.
The patient lies on a table that has tubes connected to wraps that are put around the legs from the ankles to the hips. The tubes are connected to a machine that is a computerized combination of an EKG and air compressor.
The EKG leads are attached to the chest of the patient.
During the EKG wave of the heart the air compressor is activated and the leg wraps squeeze the legs from the ankles upward to the hips.
It is noisy, like the auto tire shop. The sudden increase and decrease in pressure jostles and shakes the patient.
The purpose of the EECP is based on the discovery that this leg pressure at a certain moment in the EKG wave puts back pressure on the coronary arteries, but not on the other organs in the body. This pressure helps the heart to open new, collateral blood vessels to bypass the blocked arteries.
The patient's heart rate is the trigger for the machine to cause the compression. Thus if the pulse is 60 times a minute, it fires 60 times a minute -- or 90 times if the pulse is 90, or irregularly if the pulse is irregular.
My husband has a pacemaker ( no defib) so extra effort is required to adjust the pacemaker to avoid the machine getting confused by random normal beats and shutting down the machine. My husband gets very tired when the rate is irreg and he is bounced around to an unsteady beat.
The EECP sessions are 1 hr long, 5 days a week optimally, and require 35 sessions or at least 7 weeks, 5 times a week.
They usually increase episodes of angina during the course of treatment.
My husband is on his 3rd course of treatments in the last 5 years. They do produce good results but they are not permanent. He has more energy and his color is better.
In China, EECP is required in non-emergency situations before open heart bypass surgery is done.
My husband is in early stage Alzheimer's, has had 2 bypass surgeries, previous stents, and is not a candidate for another surgery. And he does not want more surgery. He says this is his last round of EECP as they seem more difficult for him each time.
N1K2R3, I strongly respect your opinion on defibrillators. You should base your decisions on you and your husband's beliefs. Each of us must work through these decisions in our own ways. It is NOT EASY.
I wish for all of us clarity to know our own beliefs and desires, strength to carry them out, and self-forgiveness when all we can do is our best.
My husband had a pacemaker and defibralator when he developed dementia. In his lucid moments he was very concerned with getting his advance directive in place and making sure his wishes would be followed at the end. He decided that having a defibralator was not consistent with his DNR wish, so he asked to have it removed. The heart doctor was totally amazed. He'd never had that request. He said he wouldn't do a separate procedure for that, but when it was time for battery replacement he would make the switch to only a pacemaker if Hubby still wanted that. And that is what happened. We consider the pacemaker a quality-of-life device, useful in the present.
But in your situation, PT, I would really want to know how this will improve quality of life. Even then it will be a hard decision. Best wishes as you deal with this.
Further heart surgery and stents have been ruled out. He is on Imdur and nitro as needed. He started EECP again 3 weeks ago and now is less tired, more energetic and able to play in an orchestra again.
But during the course of treatments the angina episodes become more frequent as the corolary circulation increases. He has sciatica in the left leg and an artery in the right calf is blocked with plaque. EECP is arduous. His pacemaker inserted in 2008 compounds the problems of keeping a regular rhythm in the sessions. So...........He knows he can stop treatments if he feels the gains are not worth the pain. I support any decision he makes as he is still capable in doing so.
For me, the bottom line - I would not encourage him to undergo a 4th round of EECP in another year. I am 50-50 about this session.
Could you ask to observe someone undergoing this treatment?
Good luck with this. It's hard on you, I'm sure. You sound like a very caring person.
Carol