Board index ‹ EECP ‹ Clinical Application

[jenbish]

Hi,

I have a patient who has peripheral artery disease who is receiving treatment. It has been very difficult to augment and finally now, we are starting to see diastolic augmentation, albeit tiny, they are appearing.
He tolerates the treatment very well and is truly doing well indeed. He notices the difference as he uses his GTN little and now and is able to walk up hills which he wasn't able to do prior.
So I guess my question is, what does one do, when the inflation and deflation corrections make no difference to the wave?
We are now is a position to be able to use the deflation but not the inflation corrections, to help augmentation and we have always been able to reach full pressure required since first treatment. Any thoughts on this, gratefully accepted and utilized.
Thanks for your help and expertise.

[eecpforum]

For patients with poor augmentation, you want to make sure the treatment elements you control, the cuff wrapping, timing and treatment pressure, are all optimal. Make sure they are fitted in the appropriate cuffs and wrapped tightly. The treatment pressure is crucial to creating maximal diastolic augmentation so make sure your are using the therapeutic treatment pressure for your device. Make sure your cuff inflation and deflation timing are proper to enhance the hemodynamic waveforms. I am happy to review any waveforms if you fax them to me at 1-516-997-9391.

Aside from these actions, the patient contributes a number of factors which affect diastolic augmentation including: hypertension, obesity, arterial stiffness, history of smoking, peripheral vascular disease. Over time you might notice some improvement in the diastolic aumentation which is a good sign. The data supports that patients even with lower disatolic augmentation have favorable outcomes. This is due to the fact that there are a few different mechanisms of action at work including:
-The effects of venous return increasing cardiac preload and cardiac output during cuff inflation, and reducing cardiac workload and vascular resistance when the cuffs deflate, passive exercise training effects
-Enhanced flow in the coronary circulation. Even though the disatolic augmentation might look poor at the fingertip level, the actual flow reaching the coronary arteries is usually significantly greater.
The effect of shear stress on the vascular endothelium. The endothelium is at the heart of the vascular motor tone and the ability of the arteries in particular to adapt to changes in cardiac workload and stress by dilating or constricting the vasculature as needed.

I have been at accounts where patients who take sublingual nitroglycerin frequently and tolerate it well would be given a dose of nitro at the start of EECP therapy if their diastolic augmentation is poor. The extra nitro helps to provide additional vascular dilation and a noticeable increase in augmentation during EECP therapy.

Tom Riedman, RN
Vasomedical, Inc