Enhanced External Counterpulsation (EECP)

Enhanced external counterpulsation (EECP) treatment is an FDA-approved outpatient therapy for chronic stable angina. It uses pressure on the lower limbs to improve blood flow in people with long-term symptoms of heart disease, such as chest pain and pressure.


What is EECP therapy?

Enhanced external counterpulsation (EECP) therapy is chest pain therapy approved by the Food and Drug Administration (FDA). It treats long-term chest pain or pressure (chronic stable angina) that doesn’t respond to other treatments. EECP therapy may also be recommended for some people who need a procedure to restore blood flow to their heart and aren’t eligible for surgery.

EECP therapy uses pressure to improve your blood flow. It's a noninvasive, outpatient treatment. You typically receive the treatment over seven weeks.

This type of therapy can reduce your need for medication and increase your ability to be active without experiencing symptoms. Side effects are usually minor. Your healthcare provider can help determine if you are eligible for EECP treatment.


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What is angina?

Angina is a sign of coronary heart disease that affects more than 10 million Americans. When you have angina, your heart doesn't receive enough oxygen-rich blood due to narrowed or blocked arteries. In chronic stable angina, symptoms such as chest pain or weakness come and go when you are active or under stress.

What conditions can EECP therapy treat?

Your healthcare provider may recommend EECP if you have:

EECP can also help other conditions, including:

EECP cannot treat unstable angina (acute coronary syndrome). This type of angina causes more severe, more frequent and longer-lasting symptoms. Symptoms develop suddenly, even while you rest.

Call 911 or have someone take you to the nearest emergency room if this occurs. You could be having a heart attack.


How does EECP therapy work?

EECP treatment applies pressure to blood vessels in your lower limbs. The pressure increases blood flow back to your heart, so your heart works better. When your heart pumps better, symptoms ease.

This type of therapy can also encourage blood vessels to open new pathways for blood to flow to your heart. These pathways eventually become "natural bypass" vessels that help relieve symptoms of angina if your coronary arteries are narrowed or blocked.

Who is eligible for EECP therapy?

You may be eligible for EECP therapy if you:

  • Have long-term chest pain or pressure that comes and goes during physical activity or stress.
  • No longer experience relief with medication.
  • Don’t qualify for an invasive procedure like surgery.
  • Experience renewed symptoms after an invasive procedure such as bypass surgery, angioplasty or stenting.


Who should not undergo EECP therapy?

Talk to your healthcare provider about whether you qualify for EECP therapy. EECP therapy isn’t recommended for people who are pregnant. Providers may recommend other options for people who have pacemakers or conditions such as:

Is EECP therapy a common procedure?

Hundreds of thousands of people worldwide have received EECP therapy. This treatment relieves heart disease symptoms that can’t be controlled by medicine or treated with surgery.

Procedure Details

What happens before EECP therapy?

Before you receive EECP therapy, a healthcare provider performs a physical exam and exercise stress test. Your provider also explains the procedure and equipment involved.

Immediately before treatment, a provider:

  1. Asks you to empty your bladder and change into special treatment pants.
  2. Places three electrocardiogram (EKG) patches on your chest and inflatable cuffs around your legs and buttocks. The cuffs connect to air hoses.
  3. Gives you a finger sensor to check blood oxygen and pressure levels, so providers can adjust therapy for best results.

What happens during EECP therapy?

During EECP therapy, you relax or nap on a padded table while air fills the cuffs around your lower limbs. You'll feel the cuffs grow tighter around your legs and bottom until they reach full treatment pressure.

EKG and blood pressure monitors synchronize inflation and deflation with your heartbeat. The cuffs inflate as soon as your heart rests, increasing blood supply to the arteries that deliver blood to your heart. Then they quickly deflate to make it easier for your heart to pump again.

Once you get used to the sensation, therapy should be comfortable. It shouldn’t cause pain or discomfort. You can return to your regular daily routine after treatment.

How long does EECP therapy last?

EECP therapy is an outpatient treatment. You usually have it for a total of 35 hours: one hour a day, five days a week, for seven weeks.

You can also have it twice daily for three and a half weeks. You have a one-hour session, a break and then another session.

How will I feel after EECP therapy?

Responses to EECP therapy vary. You may feel tired for several days after treatment. Most people say symptoms feel improvement in the last couple of weeks of the seven-week treatment.

Can I have EECP therapy more than once?

Talk to your healthcare provider if your symptoms return. About 20% of people need repeat EECP therapy, especially if they didn’t complete the initial 35 hour course.

Risks / Benefits

What are the advantages of EECP therapy?

Research shows many people report improved symptoms for up to a few years after EECP treatment. They say they experience:

  • Fewer and less frequent symptoms of angina, including chest pain.
  • Increased energy.
  • More ability to be active or exercise without symptoms.
  • Reduced need for medication.

What are the risks or complications of EECP therapy?

Complications from treatment are usually minor. Most people don’t experience any major side effects, discomfort or complications. In rare cases, people develop shortness of breath, requiring hospitalization and treatment.

Typical side effects include fatigue or muscle aches. Some people experience blisters or mild skin irritation due to the equipment. Others may have:

Recovery and Outlook

What is the recovery time from EECP?

EECP therapy doesn’t require a hospital stay. You can return to your regular routine immediately after treatment. Alert your healthcare provider if you experience any side effects.

Many people experience improved blood flow and reduced symptoms of angina for several years after treatment. In some cases, you may need another course of EECP therapy.

When To Call the Doctor

When should I see my healthcare provider?

If you experience frequent chest pain or pressure due to physical activity or stress, talk to your healthcare provider. Together, you can determine if you are eligible for EECP therapy. Call 911 immediately if you have unexpected chest pain that could lead to a heart attack.

Additional Common Questions

Can I be active when I’m receiving EECP therapy?

Exercise helps keep your heart healthy. Your healthcare provider can help you plan an appropriate exercise program during the treatment weeks. Talk to your provider if you plan to play sports or be sexually active during treatment.

A note from Cleveland Clinic

Angina is a common symptom of heart disease that can affect your everyday life. If you experience shortness of breath or fatigue after physical activity or stress, talk to your healthcare provider about treatment options. For some people, EECP therapy offers a non-invasive and effective way to improve their quality of life.

Medically Reviewed

Last reviewed on 03/17/2022.

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