Patients usually receive ECP treatment for 35 hours, divided into one or two 60-minute treatment sessions five days per week.

Patients who undergo two treatment sessions in one day require rest between sessions.

Treatment is administered on a padded table, where three sets of electronically controlled inflation and deflation valves are located. These valves are connected to adjustable cuffs that are wrapped firmly, but comfortably, around the calves, the lower thighs, and the upper thighs and buttocks.

Patients wear special pants during the sessions to minimize the possibility of skin irritation.

Inflation and deflation of the cuffs is triggered by the patient’s EKG signal. At the onset of diastole, the cuffs inflate rapidly and sequentially, starting from the calves and proceeding upward to the buttocks.

This increases diastolic pressure; thereby increasing coronary artery perfusion pressure and blood flow to the heart muscle.

Compression of the veins in the lower extremities also increases the volume of blood returned to the right side of the heart (preload). Simultaneous deflation of the cuffs just prior to the onset of systole lowers peripheral vascular resistance –thereby decreasing afterload, cardiac work, and oxygen consumption – and increases cardiac output.

The net effect of these physiologic changes is to increase the supply of oxygen to the heart, while decreasing cardiac oxygen demand.

This result is possible because the body has its own solution to an inadequate blood supply caused by stenosed or occluded coronary arteries.

When a coronary vessel is severely narrowed, the body’s natural response is to increase the amount of blood flowing to the heart by opening up smaller branches of nearby arteries. These smaller arteries form a network of vessels known as the “collateral circulation,” which can serve to create detours around points of occlusion.

Significant obstruction in one or more coronary arteries can create a pressure difference between areas of the heart that are perfused and those that are not.

Repeated and pulsed increases in blood pressure during diastole may stimulate both the opening and the formation of new collateral channels across this pressure gradient within the heart, resulting in increased blood supply to ischemic tissues.

The development and enhancement of a collateral circulation is particularly important in the heart where it may be lifesaving. However, collateralization is a gradual process, and not everyone has the same ability to develop these networks.

ECP appears to stimulate the natural process of developing collateral circulation. In addition, there are likely other, as yet unexplained, mechanisms that contribute to the long-lasting effects of ECP.