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“Massage” Therapy for Angina

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Effective, Non-invasive Angina Treatment

If climbing stairs, walking fast or running brings on a crushing pain in your chest, you may be experiencing angina. You should not treat this lightly. Angina is a symptom of ischemia, which occurs when blood flow to your heart slows, starving the muscle of the oxygen it needs. Though the pain typically subsides when you rest, it’s not safe to ignore it. Angina is almost always a symptom of coronary artery disease, and it should be evaluated by your physician.

A Safe and Non-invasive Treatment

First-line therapy for angina typically involves addressing the underlying problem, according to C. Richard Conti, MD, a professor of medicine at the University of Florida in Gainesville, which is usually high blood pressure, high cholesterol or diabetes. Some patients are found to have blocked arteries, which conventional Western medicine generally treats with angioplasty or stenting. Both of these can be effective, short-term solutions to open the arteries, but Dr. Conti said that some patients find they still experience angina. Also, there are some patients for whom such invasive treatments aren’t advisable, due to underlying medical problems. Fortunately, there’s another solution that is quite effective — external counterpulsation (ECP) therapy, which significantly reduces or eliminates angina about 70% of the time.

In contrast to the other treatments available, ECP isn’t all that complicated or high tech. The technology itself resembles a large, comfortable reclining chair. The patient sits and a technician wraps three pressure cuffs — similar to but slightly larger than standard blood pressure cuffs — around the calves, lower thighs and upper thighs or buttocks. The cuffs inflate and deflate, compressing and releasing blood vessels in the limbs to move blood toward the heart. This “unloads” the heart by relaxing pressure in the arteries while the heart is pumping, Dr. Conti explains. As the cuffs inflate and deflate in harmony with your cardiac cycle, they encourage optimal coronary blood and oxygen flow. This action relieves chest pain and improves exercise tolerance, which means that you can begin to work out again without discomfort — another plus for heart health.

A standard course of ECP treatment consists of 35 one-hour outpatient sessions over a period of seven weeks. This is a big time commitment, Dr. Conti acknowledges, but he finds that angina sufferers are willing to put in the time if it gets rid of their pain. If the treatment is successful but angina eventually recurs, it can be repeated. Outcome varies — some patients obtain relief that lasts for years. Note: While ECP is generally safe, doctors do not recommend it for people who have conditions such as phlebitis, peripheral artery disease or a leaky aortic valve, because it can lead to complications.

More Extensive Use of ECP in the Future?

Health insurers generally cover ECP for angina but only after standard medical and surgical care fails to control it. Dr. Conti notes that treatment may be beneficial earlier, for example as a complement to medical management before surgery proves necessary. Since this has not been demonstrated in trials, it’s not typically covered by insurance. Data also suggests that ECP may benefit people with heart failure, but again further study is needed. If new research continues to demonstrate expanded benefits, however, treatment — and coverage for treatment — is likely to be extended as well.

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Source: C. Richard Conti, MD, professor of medicine, division of cardiovascular medicine, University of Florida, Gainesville, Florida. Date: November 19, 2009 Publication: Bottom Line Health
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