Can EECP treat severe heart problems?

Question

Hello doctor,

I am writing to seek your guidance regarding my brother's severe heart problem. He is 56 years old, and the impressions from his recent echocardiogram reports are as follows:

Report 1, taken three months ago, represents

Normal cardiac size.
AWMA+ (Septum, apex, anterior wall, mid and apical Lateral wall hypokinetic)
Severe LV dysfunction.

Report 2, taken a month ago, shows

Dilated LA or LV.
RWMA (septum, apex, anterior wall, inferior all akinetic).
Moderate LV dysfunction.
Grade-I diastolic dysfunction.

Initially, four months ago, he opted for Ayurvedic treatment instead of undergoing an angiogram. However, we convinced him to consult a renowned cardiologist. Instead of proceeding with an angiogram immediately, the doctor conducted additional blood tests and another echocardiogram. The impressions were as follows

Serum creatinine at 1.5 mg/dl.
Normal chambers.
Normal valves.
Normal wall thickness.
LV dysfunction.
Mild TR.

The doctor prescribed the following medications and recommended a follow-up after 15 days. Tablet Angispan-TR, tablet Storva gold 2.0, Dytor Plus-5, Arnipin 50. Additionally, Sorbitrate was prescribed for chest pain relief. Unfortunately, my brother is reluctant to undergo allopathic treatment, even after consultation. He is particularly apprehensive about an angiogram and refuses further treatment like angioplasty or surgery.

I would appreciate your insights on the following:

Can EECP treatment be considered for my brother, and when would be an appropriate time for him to undergo this treatment?
Is EECP treatment aligned with conventional approaches like angioplasty and surgery?
Why might the doctor have delayed the angiogram?

Kindly guide.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

EECP (enhanced external counterpulsation) is typically not an initial treatment, as it may sometimes offer little or no benefit. It is primarily considered for individuals experiencing angina that is not effectively controlled with medications, angioplasty (a medical procedure that involves widening narrowed or blocked blood vessels), or bypass surgery, which involves redirecting blood flow around a blocked artery using a graft. In essence, it is considered a last-resort option. While EECP is documented in the literature, it is generally reserved for specific situations where other treatments have not yielded satisfactory results.

In cases where a low ejection fraction is newly diagnosed, angiography (a medical imaging method using X-rays and contrast dye to visualize blood vessels for diagnostic purposes) is recommended as a first step. If arterial narrowing is identified, the subsequent course of action depends on factors such as the extent, severity, and symptoms. Treatment options may include medications, angioplasty, bypass surgery, or additional tests for further evaluation. The delay in recommending angiography could be influenced by factors such as a creatinine level of 1.5 mg/dL or the need to conduct other tests, such as a nuclear stress test or stress echocardiography, before proceeding.

I suggest emphasizing the importance of continuing prescribed medications. Convey to your brother that choosing not to undergo treatment may lead to further weakening of the heart over time. Early intervention is essential for managing and improving his condition.

I hope this helps.

Please revert in case of further queries.

Thank you.