Contraindications of EECP

 Contraindications to EECP include severe peripheral vascular disease and significant aortic insufficiency.

 COntraindications for EECP/ ECP

Similar to the intra-aortic balloon pump, contraindications to EECP include severe peripheral vascular disease and significant aortic insufficiency. Other contraindications include:

Significant unprotected left main disease
Atrial fibrillation
Any severe valvular heart disease
Uncontrolled hypertension (blood pressure > 180/100 while on medications)
Phlebitis
Deep vein thrombosis
Lower extremity stasis ulcers
Bleeding diathesis (including INR > 2.0)
Pregnant or potentially pregnant women
Atrial fibrillation is a relative contraindication, because the varying heart rate makes it impossible to time the inflation and deflation of the cuffs. In the subset of individuals with atrial fibrillation, high degree heart block, and a permanent pacemaker who are pacemaker dependent, it may still be possible to perform ECP.

Precautions

Patients with blood pressure *higher than 180/110 mmHg* should be controlled prior to treatment with enhanced external counterpulsation.

Patients with a heart rate of more than *120 bpm* should be controlled prior treatment with enhanced external counterpulsation.

Patients at high risk of complications from increased venous return should be carefully chosen and monitored during treatment with enhanced externalcounterpulsation. Decreasing cardiac afterload by optimizing cuff inflation and deflation timing may help minimize increased cardiac filling pressures and the possibility of pulmonary congestion due to increased venous return.

Patients with clinically significant valvular disease should be carefully chosen and monitored during treatment with enhanced external counterpulsation.

Certain valve conditions, such *as significant aortic insufficiency* or *severe mitral or aortic stenosis*, may prevent the patient from obtaining benefit from diastolic augmentation and reduce cardiac afterload in the presence of increased venous return.