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CARDIO VASCULAR CARTOGRAM
For the first time in TamilNadu, to detect coronary blocks we have cardiovascular cartogram and avoid bye pass surgeries. Cardiovascular cartography is a technique that is keyed to studying physiological (functional) effects that are secondary to an anatomical (structural) cause. It externally maps the coronary arteries by subtracting the myocardial structures such as pericardium, myocardium, and endocardium and shows the clear picture of coronary artery anatomy in LAO (Left Anterior Oblique) and RAO (Right Anterior Oblique) view.

By this complex technology one can know the number, nature of coronary artery blocks, and the extent of collateral circulation. One can also learn whether the blocks are amenable to medicines or not. If they are amenable to medicines, one can get rid of them with medicines alone. If not one can get rid of the blocks with the help of SECP.
S.E.C.P (Sequential External Counter Pulsation)
ECP is a noninvasive, therapy for patients suffering from coronary Artery Disease and congestive Heart Failure. Clinical studies over the past several years have show that about 75-80% of patients treated with single course of ECP experience a reduction in angina and are able to return to a more active life-style. It is approved by USA (FDA) in September 2000 for the treatment of coronary Artery Disease and in 2001 for Congestive Heart Failure. ECP is also approved in England (NHS), Europe, Australia, China, Etc.

ECP treatment is an option for patients who are unsuitable for or unwilling to undertake invasive procedures. For patients who have undergone multiple invasive procedures and/or carries excessive risk for additional surgery, ECP treatment may be the only way to obtain relief from crippling angina. Generic name of this treatment modality is "External Counter Pulsation (ECP)," whereas EECP, SECP, AECP, IECP are registered brand names.
Recent Events

Progress in treatment of coronary Artery Disease

THE PRESIDENT OF INDIA
ADDRESS AT THE 2ND CONGRESS ON INTERVENTIONAL CARDIOLOGY AT MUMBAI - 2005

"We have all witnessed the treatment of cardiovascular disease moving from very invasive to less invasive methods .In the seventies by pass surgery was the big news ,in the eighties it was balloon angioplasty and in the nineties it was the stent.

Now, moving a step further is a total non-invasive treatment-EXTERNAL COUNTER PULSATION (ECP) a truly non-operative, non-pharmaceutical, safe and effective treatment which has made big news in the west, ECP (USA) approved and cardiology textbooks. Many favorable articles have been published in the journal of the American college of cardiology, cardiovascular reviews, reports, cardiology Mayo Clinical Proc., Clinical Cardiology, journal of medical illness, journal of external counter pulsation, etc.,The success of ECP can be judged from the fact that in USA, THE INSURANCE SECTOR reported that the reimbursement for ECP has gone upto 6%whereas that of the other procedure like bypass surgery, angioplasty, etc., has come down by 7%. Now the treatment is available in most of the leading hospitals of the world.

It is well known the following by pass surgery-only75%pqatients are symptom free for 5 years or more. The number of patients having recurrence after bypass, ballooning and stenting is increasing and for them ECP is the only FDA approved treatment available which is documented to increase blood supply to the heart by 20-42%to the brain by 22-26%and to the kidneys by 19%. ECP also increases heart's output. More patients now prefer non -invasive treatments. With improved carebral circulation patients may notice improved memory".

External counter pulsation is another promising alternative treatment of refractory angina. Data suggest that ECP reduces the frequency of angina and the use of nitroglycerin and improves exercise tolerance and quality of life. In a randomized, double -blind, sham-controlled study of ECP for patients with chronic stable angina, counter pulsation was associated with an increase in time to ST segment depression during exercise testing and a reduction in angina. It is also reduced the extent of ischemia detected with myocardial perfusion imaging.

Braunwald's text book of Cardiocascular Medicine: Edition 7th, page 1308
ECP utilizes pneumatic cuffs on the lower extremities to provide diastolic augmentation & systolic unloading of blood pressure in order to decrease the cardiac work & oxygen consumption while enhancing coronary blood flow. Recent trials have shown that regular application improves angina, exercise capacity and regional mycocardial perfusion

Harrison's principles of int. medicine: edition 16th, vol. II, page 1441
One case report of million, illustrates the capacity of SECP to revascularize the heart and control symptoms in patients who have not benefited from balloon angioplasty or bypass surgery. The authors describe a 58year old man who required 2 separate bypass surgeries, six rounds of angioplasty involving over 20 narrowings, and multiple heart catheterizations, all within 26 month time period. Finally, one artery closed off completely and further angioplasty was not possible. The patient was then begun on SECP and experienced a "dramatic "reduction in symptoms within 3 weeks. Upon completion of a 120hour course, this patient's stress nuclear scan normalized and angina fully resolved. Three years out from SECP he remains asymptomatic. Enhanced External Counterpulsation as an adjunct to Revascularization in Unstable Angina, Lawson WE, Hui JCK, Oster ZH, et al. clinical cardiology 1997; 178-180.
Press Releases

RIBUNE NEWS SERVICE - 04/11/2001
The best brains in the country ar coming together to mend the heart! If the latest in treatment of heart ailments is anything to go by, the wonder treatment of the millennium is surely going tobe non invasive, cost-effective procedure that seeks to treat heart problems and enhance the quality of life of patients by simply bypassing surgery!

Speaking at an impressive gathering of leading national and inter-national cardiologists and surgeons at the first all-India EECP conference 2001 today, eminent cardiologist Dr. Naresh Trehan Director, Escorts Hearts Institute and Research Center, said the EECP treatment was very popular and China and already more than 1500 centers had been established within a short period of time."and efficacious procedure. It is a proven non- invasive outpatient procedure to relieve the angina by increasing the oxygen delivery to the muscles". he added.
INDIAN EXPRESS, The sunday Story - 7/3/04

PATIENT OUTSOURCING
London resident keith Deckinson has been receiving daily therapy at the EECP lab at Escorts, New Delhi. The treatment is noninvasive procedure to reduce the symptoms of angina, by increasing coronary blood flow in the heart.
Only 2 hospitals in London offer this treatment & waiting list is huge, says Deckinson.
His medical tab: Rs. 80,000 in India. In the UK, it would have been closer to Rs. 10 lakh.
TRIBUNE NEWS SERVICE
Dr. Harbans S. Wasir, former Professor and Head, Department of Cardiology, Batra Hospital, says the EECP technique without surgery and angioplasty could decrease the serverity and frequency of angina. This treatment could decrease the need for medication and improve the ability to participate in normal day-to-day activities. ECP can be administered in outpatient sessions and carries no risk, is comfortable and stimulates the opening of new natural pathway around blocked arteries, said Dr. Wasir, advocating the benefits of the new procedure.