External Counterpulsation and method of minimizing end diastolic cardiac external counter pulsation angina therapy-external counter therapy
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External Counterpulsation and method of minimizing end diastolic cardiac external counter pulsation angina therapy-external counter therapy
   For the Doctors
 
External Counterpulsation and method of minimizing end diastolic cardiac external counter pulsation angina therapy-external counter therapy
   For the Patients
 
  External Counterpulsation and method of minimizing end diastolic cardiac external counter pulsation angina therapy-external counter therapy  
 

The current model of the ECP machine includes a treatment bed, which has an inbuilt compressor and a control console. The inflation/deflation valve, which are incorporate in to the bed, have 3 outlets to which 3 pairs of cuffs are attached via hoses. The R wave of the patient's ECG is used as a trigger signal for inflation and deflation: on detection of R wave, a delay of 0.4 times the square root of the preceding R-R interval is used to initiate inflation. Simultaneous deflation of all cuffs occurs 50 milliseconds before the next anticipated R Wave. The control panel, which is used to adjust the cuff pressure and the timings of the cuff inflation, also provides both ECG monitoring and monitoring pulse augmentation by finger plethysmograph. In clinical practice the upper limit of the pressure is 250-275 mmHg.

The patient is made to relax comfortably on the padded bed while a trained nurse or therapist wraps the patient's calves, and thighs with pneumatic cuffs which are similar to blood pressure cuffs. Hoses connect the cuffs to an air pressure/vaccume pump enclosed within the bed base. The cuffs are sequentially filled with air during diastole, when the heart is momentarily at rest between beats. The cuffs are inflated during diastole in a timed sequence: the calves first, followed by the thighs and then the upper thighs. All the pressure is released at the onset of systole. The compression of lower extemities increase venous return and augments arterial diastolic pressure. The control panel of the ECP device, which is used to adjust cuffs inflation and deflation, also provides both ECG monitoring and monitoring of pulse augmentation by finger plethysmograph. The lower extermities venous beds are sequentially compressed, with a 'milking effect' at the same time as arterial beds. Compression of the cuffs during diastole forces blood from the legs up to the heart, reducing the work effort of the heart and increasing the flow of blood through the coronary arteries to the heart muscles.

 
     
  External Counterpulsation and method of minimizing end diastolic cardiac external counter pulsation angina therapy-external counter therapy  
     
 
    As diastole begins, the cuff inflate rapidly from calves to the buttocks, firmly compressing the patients vascula ture. These two have immediate effects:

  1. A strong retrograde 'counterpulse' occurs in the arterial system, forcing freshly oxygenated blood back towards the heart and the coronary arteries.

  2. An increased volume of venous blood is returned to the heart under increased pressure.

    The combined effect of these two events is to increase the oxygen supply and perfusion pressure in the myocardium (heart muscles) and to increase 'preload' so that the heart has a greater volume of blood to pump during the next cycle as the heart nears the end of diastole and prepares for systole (ventricular contraction). The computer instructs instantly the deflation valve to open so a vaccum can deflate the cuffs instantly. This action also provides therapeutic advantages by reducing heart 'afterload'. Since the vascular beds in the lower extremities are nearly empty, the resistance to blood flow is markedly reduced, thereby decreasing the amount of work that the heart must do to pump blood to these areas (reducing oxygen demand within the myocrdium). As a result of these diastolic augmenetation activities, the patient's peak diastolic pressure is significantely increased, benefiting circulation in the heart muscle and in other organs as well. At the same time, the patient's systolic pressure is reduced, to the general benefit of the vascular system.
 
     
     
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