1 – Why EECP therapy is not widely used in the treatment of heart disease?
Nowadays, it is more popular to treat heart disease with high-technology procedures, 
Therefore, cardiac centers spend a lot of money to set up operation rooms and intensive care units to start to those high-tech procedures such as, balloon-stent and coronary bypass operation for coronary artery disease, pace maker, artificial heart implantation and heart transplantation for heart failure. Then, the doctors in these centers should treat their patients with these available high-tech procedures even though these procedures are expensive, invasive and inherent of some risks.
EECP treatment, on the other hand, is a low cost, no risk, easily applied, non-invasive procedure, usually applied on outpatient basis without necessitating a stay at the hospital. EECP also decreases the frequency of emergency hospital admissions, the need for repeating diagnostic tests including coronary angiography, the need of repeating treatments including balloon-stent application, as EECP have preventive effects against atherosclerosis and delays heart disease progress. EECP also provides a more comfortable treatment option and a better quality of life, for heart failure patients.
When patients with heart disease learn about EECP’s advantages, they usually refuse to have other invasive treatment options. Therefore, the patients can get information about EECP treatment only from those doctors who apply EECP. 
 2 - Does anybody feel any pain or discomfort during or after EECP ? 
No one feels any pain or discomfort during or after EECP.
The only thing that is felt during EECP is a rhythmic massage like feeling with tightening and loosening of the lower part of the body with every heart beat. Most of people watch television or fall asleep during EECP treatment
3 - How is EECP adjusted according to heart beats. Why it is needed?
Electrocardiograms (ECG) of the patients are recorded continuously during EECP application. ECG helps to adjust the timing of the tightening and loosening of the lower part of the body in accordance with the heart beats.
4 - How long does an EECP treatment program last?
It depends on the severity of the heart disease.
Mild – moderately ill patients usually recover with 35 hours of EECP treatment and their well being period may last up to 3-5 years.
Severely ill patients may need further hours of EECP treatment to recover.
Heart failure patients with severely depressed cardiac function may need continuous EECP support for their failing heart on a 2-3 hour/week basis, to manage their daily physical activity and to be back on their daily routines, like renal failure patients who continue with their lives with dialysis treatment 2-3 times/week.
5 - What is the program for EECP treatment application?
35-hour EECP treatment course is usually applied for 1 hour everyday for 5 days of the week and is completed in 7 weeks.
For the patients who come from outside the city or who are severely ill, it is applied for 2-3 hours/day and the 35-hour treatment is completed in 3-4 weeks time.
6 - Is it necessary to stay in the hospital during EECP treatment?
It depends on the severity of the heart disease.
Very sick patients may need to be in the hospital till their condition is stabilized.
Otherwise, EECP therapy is applied on an outpatient basis. After having 1-2 hours of treatment, the patient can return to his/her daily life.
7 – Is there any preparation before EECP treatment?
The most important preparation before EECP treatment is the examination by a cardiologist in order to exclude any risk, to assess the severity of the disease and to decide how to apply the treatment.
8 –Is there any need for a doctor’s examination before EECP treatment?
Before deciding on EECP treatment, an assessment by a cardiologist who will apply the EECP treatment is certainly needed. The cardiologist needs to assess the severity of the disease, to exclude any risk and to decide how to apply the treatment. 
After physical examination, the doctor may ask some tests for a better evaluation.
9 - Which tests are needed before EECP treatment?
Electrocardiogram, echocardiographic examination, stress test on treadmill, myocardial perfusion scintigraphy and coronary angiography are needed to assess the status of the heart disease.
In addition, the ultrasound-Doppler examination of the neck arteries, abdominal aorta, leg arteries and veins are needed for further evaluation.
Blood tests are also needed to evaluate, blood sugar and lipid levels; kidney, liver, thyroid function; blood count, electrolyte, iron, vitamin levels; ect. 
10 – How are the beneficial effects of EECP treatment assessed?
The most important evidence of the benefit obtained from EECP treatment is the feelings of the patient who receives it. From the initiation of EECP treatment, the patient starts to feel better day by day, with decrease of the symptoms of chest pain, shortness of breath, fatigue;  feels himself/herself more energetic; and starts doing his/her daily physical activities which were limited before treatment.
The patient will also decrease the number of drugs used with the progress of the EECP treatment. 

11 – When the beneficial effects become apparent after EECP treatment?
Some patients feel better soon after the initiation of treatment.
More prominent well being signs occur, after 15-20 hours of treatment.
12 – Are there any tests needed to be repeated after EECP treatment?
Most of the patients are satisfied with the results of the treatment and with the decrease of their symptoms, they do not want any tests to be repeated in order not to spend time and money.

13 – Could it be possible to prove the beneficial effects of EECP treatment by tests? 
Yes, of course.
We usually repeat the non-invasive tests after EECP treatment to assess how much progress was made with the treatment. These tests include: “Exercise test on treadmill” which shows the increased exercise duration after treatment or “Nuclear study with exercise” to demonstrate both the amount of improvement in blood supply of the heart and also the improved exercise capacity of the patient. 
For patients who are in heart failure, we usually repeat ultrasound examination of the heart (Echocardiography) to assess the improvement in heart size and performance.
14 - Are there any side effects or complications of EECP treatment? 
There is no serious side effect or complication reported over 30 years of applications all over the world and over 13 years of our applications. This safety can be obtained by selecting the patients carefully before treatment and excluding those who may have any side effect.
Great care is also necessary during application of EECP treatment, especially to those is in heart failure. 
15 – Are there any situations or diseases that EECP therapy may have side effects or complications?
Yes, there are.
Patients who have significant aortic valve insufficiency, significant dilatation or aneurism of the ascending or abdominal part of the aortic artery, thrombophlebitis or presence of clot in the lower leg veins, hematologic disease with a tendency of bleeding, active cancer in any organ of the body are prone to some side effects or complications of EECP treatment. 
Therefore, these patients should be excluded from EECP treatment, with the examination of the cardiologist, before treatment.
Also, patients with severe heart failure, significant hypertension and arrhythmia with high pulse rate, are first stabilized by medical treatment and then treated with EECP.
For patients who had coronary angiography through femoral artery, EECP should be initiated about one week later, to avoid bleeding.
Patients who had coronary stent can receive EECP treatment one month after the operation and those who had coronary bypass surgery can have it two months later.
16 – Should the drugs used by the patient be stopped during EECP treatment?
At the beginning of EECP treatment, all the drugs which are prescribed for coronary heart disease, heart failure, hypertension, diabetes and high cholesterol are used according to their instructions. 
With the progress of EECP treatment, there may be the chance to decrease the number of the drugs used.  
17– Will it be necessary to repeat the EECP treatment? 
It depends on the severity of the disease.
Patients who have heart disease of mild to moderate severity, may not need to repeat the EECP treatment for 3-5 years, when they become symptom free after treatment.
More severely ill patients may need to repeat EECP treatment every 3-6 months.
Patients with severely depressed cardiac function and overt heart failure may survive with continuous EECP support on a 2-3 hour per week basis, till they get heart transplantation.
18 – Could all heart disease patients get benefit from EECP treatment? Which heart disease patients get benefit?
All patients with coronary artery disease, whose cardiac arteries have narrowings due to atherosclerosis, can get benefit from EECP treatment.
Also, all patients with heart failure which developed after occlusions of heart arteries and heart attack, can get benefit from EECP treatment.
19 - Is EECP used for the prevention of heart disease?
EECP treatment is used to prevent the development of atherosclerosis and coronary artery disease, to slow its progress, to prevent or delay the complications including myocardial infarction and heart failure.  
20 - Does EECP Treatment have preventive effect against heart attacks?
Yes. EECP can prevent heart from the danger of a heart attack by two ways:
1 – EECP prevents and delays atherosclerotic developments, and thereby narrowings and occlusions of the coronary arteries.
2 – EECP enlarges coronary arteries and increases small arterial network producing natural bypasses to improve blood supply to the areas which have reduced blood flow due to arterial narrowings and occlusions.
21 – Is it possible to treat all patients with coronary artery disease by EECP therapy instead of invasive procedures such as balloon-stent or bypass surgery?
EECP, balloon-stent and bypass surgery are three options for the treatment of coronary artery disease.
The most convenient treatment for a particular patient can be decided by clinical examination and by diagnostic tests including ECG, exercise test, echocardiography, myocardial perfusion study, coronary angiography and blood tests.
If there are some significant narrowings at some points of coronary arteries which are suitable for balloon-stent or bypass surgery, these procedures are applied first.
If the coronary arteries are small in caliber or diffusely diseased, so that they aren’t suitable for any invasive procedure, then EECP is the treatment of choice.
Unfortunately, centers which do not have EECP facility and doctors who do not apply EECP, don’t take EECP into consideration. 
Even severely disabled patients who do not have any chance for repeat balloon-stent application and bypass surgery, but will have  the chance to recover by EECP are usually not referred to EECP therapy, since most doctors do not have much information and experience about the beneficial effects of EECP.
Therefore, patients and their relatives should learn about EECP treatment and ask the cardiologist who also applies EECP, to decide which treatment is the best option for them.

22 – What are the differences and similarities between “Bypass Operation” and “Natural Bypass Treatment by EECP”?
In case of bypass operation, small pieces of vessels obtained from different parts of the body are used to produce bridge vessels on the narrow points of the vessel therefore providing blood supply to the distal end of the narrowed vessel to feed the area with decreased blood supply.
In case of Natural Bypass by EECP, existing vessels are enlarged and new small vessel formation is promoted to feed the areas with decreased blood supply.
Similarity is that both methods promote blood flow to the areas with decreased blood supply.
Difference is that bypass operation is a serious operation. On contrast, EECP is a non-invasive, no-risk, external massage like procedure.
23 – Is EECP treatment used in patients who had bypass surgery?
After bypass operation and before the recurrence of the disease, EECP treatment prolongs the well being duration, delaying the atherosclerotic process and development of new narrowings, especially for those patients with small vessels as usually seen in diabetics and female patients.
After the progress of the disease, when diffuse narrowings develop at many points of the coronary arteries without any possibility of re-operation, then EECP treatment is the only treatment option for that patient.  
24 – Is EECP treatment used in patients who had balloon-stent applications?
After stent application and before the development of re-stenosis, EECP treatment helps to delay the re-stenosis at the point of stent application and delays new narrowings at the other parts of the arteries.
After the progress of the disease, when diffuse narrowings develop at many points of the coronary arteries without any possibility of re-opening with stents, then the EECP treatment is the only treatment option for that patient. 
25 - Does EECP have any favorable effects to those who don’t have any heart disease?
Yes, of course.
EECP increases blood circulation all over the body by means of rhythmic massage applied externally on the lower part of the body.
Professional sportsmen can benefit from this. Metabolic products that accumulate in the exercised muscles which cause fatigue can be more quickly and completely removed from the tissues, in comparison to the manual massage usually done for this purpose after training.
People who look healthy but have risks of atherosclerosis and coronary artery disease can get benefit from EECP. In those who have diabetes, hypertension, high blood lipids, and heart disease in close relatives, EECP can delay the occurrence of coronary artery disease by its preventive effect against atherosclerosis development. 
EECP is also used for anti-aging purposes, to delay the symptoms and signs of aging.
26 - Is EECP treatment used in non-cardiac diseases?
Yes it is. EECP increases the blood circulation and improves function in all organs of the body. Therefore, it is used in many diseases of the organs due to decreased blood supply. 
Some examples include:
Stroke, due to the occlusion of one of the brain arteries by a cloth, not due to hemorrhage,
Sudden blindness, sudden deafness,
Mild-moderate renal failure,
Peripheral arterial disease,
Sexual impotence,
Chronic fatigue, exercise intolerance and lack of physical conditioning,
27 – Is EECP treatment used in patients with heart failure?
Yes, EECP is used in the treatment of patients with heart failure. 
EECP, improves blood supply to the heart, supports its contractions and decreases its workload, increases blood flow to the kidneys and urine output, thereby decreases the fluid accumulated in the body. 
The final effect of all those is reduced symptoms and signs of heart failure and improved quality of life.
28 – Is EECP treatment used in patients with hypertension?
Yes. EECP helps to reduce blood pressure of patients whose hypertension could not be reduced with drug therapy.
29 – Is EECP treatment used in patients with cardiac rhythm problem?
Yes. When rhythm problem is due to reduced blood supply, EECP helps to control the problem.
30 – Is EECP treatment used in patients with pace maker?
31 – Is EECP treatment used on patients with diabetes?
Yes, of course. 
In fact the patients who have diabetes are the group of patients who has the chance to get the most prominent benefit from EECP treatment. 
Because, EECP has highly dramatic beneficial effects on all the unfavorable features inherent in diabetics to promote atherosclerotic developments. 
Namely; diabetics have small coronary arteries which facilitate the occurrence of significant and widespread narrowings at early stage of the disease. Also, high blood sugar in diabetics damages the inner surface of the arteries and promotes atherosclerosis. 
EECP enlarges the arteries, opens up the small non-functioning vessels, promotes new small vessel formation and increases vascular arterial network. In the meantime, EECP enhances blood supply of the pancreas, increases insulin secretion and facilitates blood sugar control. 
Final effect of EECP is to prevent and delay atherosclerosis, increase blood supply of the heart in the presence of coronary artery disease.
32 – Is EECP treatment used on patients with renal failure?
Yes, of course.
EECP increases blood circulation in the kidneys, thereby increases urine output.
A remarkable effect of EECP is observed in patients with heart failure, immediately after initiation of EECP therapy, urine output increases followed by decreases in fluid accumulation in the body and body weight.
In patients with mild to moderate renal failure, EECP treatment is used to reduce elevated urea and creatinin levels.
33 – Is there any age limitation for EECP application?
There is no age limitation for EECP application. EECP is applied over age of 80’s


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