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How will I know if the collateral has formed after EECP treatment?


The patient after undergoing  35 days of EECP treatment can improve the blood supply to the heart muscle. Even in patients with multiple blocks the blood can now flow across the blocked artery through the formation of new vessels, these newly formed vessels are called collateral vessels. Now how as a patient, I can know that this collateral has created after 35 days of EECP treatment. First is a subjective assessment after EECP, the patient, now should able to walk more distance. Then all cardiac complaints or clinical symptoms which he had before like lack of sleep, lack of appetite shortness of breath, chest pain, unable to walk a short distance or even routine activities causing him discomfort should reduce or eliminated after the 35 days of treatment.

This is a piece of clear evidence to show the blood flow is restored.  The other way to know is as a physician if you want to know clearly whether the collateral has developed and blood flow is improved then a simple ECHO cardiography can be performed. In some patients whom the heart function is not adequate because of lack of blood flow then after 35 days of treatment, they can see the pumping efficacy has improved marginally or significantly.

Second is a myocardial perfusion scan or SPECT nuclear scan.  How it is done is before the patient starts EECP, we can do this test to assess where blood flow is deficient.  Then after completing 35 days of treatment, the patient can be subjected to undergo the same nuclear scan again so that now we can able to show improvement in the blood flow to the area where there is a deficiency before. Also, we can do a simple thread mill before the treatment.   The patient may able to do around 5 to 6 minutes in the treadmill, and then there is a significant change in the ECG.  Now after completing the treatment, the same patient can able to perform much longer duration and some times you may not be able to see any changes in the ECG  even if you are exerting to the maximum level. That shows the blood flow is improved significantly. All these tests are clinical proof to show by doing 35 days of EECP there is an increase in blood flow to the myocardium. This increase blood flow to this heart muscle is purely achieved because of what we call as collateral circulation.