John Haan, Enhanced External Counterpulsation (EECP):

There was a time not too long ago when playing a complex piece of music on the church organ on Sunday mornings would bring on the chest pain that troubled John H. Haan for many years.

No more.

Four years ago Haan, 69, underwent a unique procedure at the Borgess Health and Fitness Center that helped his heart work better.

Called Enhanced External Counterpulsation (EECP), the procedure increases the blood flow to the coronary arteries and reduces the work required for the heart to pump blood.

"It’s a painless procedure and I’ve never experienced angina since," Haan said. "Now I can mow the yard without stopping, sweep the garage floor without chest pain."

And he can play the most complex musical piece on the organ without discomfort.

"It has been a dramatic change in my lifestyle. It was the answer I was looking for."

EECP, as it is called, is a mechanical procedure in which long inflatable cuffs, like blood pressure cuffs, are wrapped around both of the patient’s calves and thighs and the abdomen.

The patient lies on a bed while the cuffs are inflated and deflated in a motion synchronized with each heartbeat. A computer controls the timing, inflating the cuffs just as each heartbeat ends and turning off the pressure just as each heartbeat begins.

Cuffs inflate from the bottom up so that the blood in the legs is squeezed upward, into the coronary arteries. And by deflating just as the heart begins to beat, the procedure causes a vacuum in the arteries, which reduces the work of the heart muscle in pumping blood.

Haan, as with all patients, underwent the hour-long EECP procedures five days a week for seven weeks.

A randomized trial with EECP, published in the Journal of the American College of Cardiology in 1999, demonstrated that EECP significantly improved both the symptoms of angina and exercise tolerance in patients with heart artery disease. More recent studies have found that EECP improved symptoms for up to five years.

Haan has a long history of heart disease, although he has never had a heart attack.

A self-described "triple-A type personality," Haan began feeling the chest discomfort called angina in his 20s and 30s. Many times he would have to stop while walking to ease the discomfort, blaming the problem on the fact he was out-of-shape.

He said he has a family history of heart disease and was not surprised that he had problems.

The discomfort progressed and when he was 45 and in Las Vegas it got so bad that he decided to see a physician. He underwent a stress test at Borgess Medical Center and an angiogram showed that two of the three main heart arteries were 100 percent blocked.

He underwent bypass surgery at Borgess and cardiac rehabilitation at the Health and Fitness Center.

Angina, however, persisted.

"I had some additional capacity, but limited benefit from the bypass surgery," he said.

Haan was told that in some people the veins taken from the legs that are used in bypass surgery begin to be dissolved by the body, and that may have been the cause of additional discomfort.

Six years later Haan underwent a second bypass operation, this time at the Cleveland Clinic where doctors were using a new procedure that bypassed blocked heart arteries by splicing in arteries already in the chest.

The procedure is called a mammary artery bypass.

"After the second operation I had some angina pain on occasion," he said. "But five angiograms could not find the source of the pain."

In 2000, Haan, a financial advisor, had a client who also had had bypass surgery and who had a more severe case of chronic angina. The man had been invited to participate in an EECP pilot program at the Mayo Clinic and told Haan afterwards that he was very satisfied with the results.

"I talked to the folks at the Health and Fitness Center about the procedure and they researched it," he said. "In November 2000 they bought the equipment."

A few months later Haan was the third chronic angina patient to undergo the five-week treatment, which is offered by the Borgess Heart Institute.

"I would lie in bed and watch TV or read," he said. "They had a doctor on the scene just in case.

"After about three weeks it seemed to have some benefits. I felt better. By the time it was finished, I had no pain what-so-ever."

Vickie Asaro, manager of cardiopulmonary rehabilitation and EECP at the Health and Fitness Center, said that Haan had come to them in 1999 and asked about doing EECP.

"We had never heard of it," Asaro said. "We had a resident physician research EECP and he favorably presented to the staff."

Since the program was up and running in late 2000, 120 patients have completed all 35 sessions, Asaro said, many with dramatic results comparable to Haan's.

Angina is categorized by severity, ranging from very mild class 1to class 4, which is severe chest pain. Asaro said that 44 percent of the patients were treated for class 3 angina and 56 percent for class 4. After 35 sessions, 1 percent still had class 4 pain and 7 percent class 3, Asaro said.

Forty-five percent reported class 2 discomfort and 47 percent class 1.

Some patients have had a second 35-course session. "The need for a repeat depends on the person," Asaro said.
Haan since has talked to others about angina and the need to act when the body cries out for help.

"Heart disease is slow in coming on, unless you have a heart attack – which I never did," he said. "Like so many people, I was in denial. Angina is a physical signal to slow down and stop what you are doing."

The discomfort from angina is different from muscle pain, he said. In his case the angina was a throbbing pain in his back that eased when he rested. Muscles pain, he said, persists even when resting.

"If you wake up in he night with pain, you have a severe problem," he said.

Haan has also made adjustments in his approach to life.

"I was very active, a triple 'A' type personality," he said. "Now I’m a type 'C' personality," someone who recognizes that temperament can trigger chest pain in vulnerable people such as himself.

He sought help learning relaxation techniques and "now I can relax in five seconds."

"EECP has given me extra blood flow and the relaxation techniques has helped reduce tension. When I play the organ now it’s a day-and-night difference from five years ago. I’m more relaxed and I don’t tense up.

"And I probably play with more expression now."

Haan praised Borgess for adding the EECP treatment even though not all cardiologists view it as helpful.

"The Borgess staff is highly personable and one-on-one," he said. "The Cleveland Clinic was very professional, but the people at Borgess are much, much more personable – the cardiologists, nurses, recovery – everything that goes along with it.

Haan has also come to respect his new approach to life.

"I know I’m not going to conquer the world, that I’m not going to shoot par on the golf course," he said. "I can enjoy golf no matter what the score.

"When you have heart trouble, little things in life can affect your blood flow. If you have angina or arrhythmia, you know what brings it on.

"I was the classic pile-driver. When you run ahead of the crowd you can stay ahead of the crowd. But you pay a price. In my case it was heart problems."

People who have any symptoms of heart disease should not ignore it, he said.

"You have to deal with denial," he said. "Don’t put it off. It’s better to know than to wonder. If you know what you have you can deal with it."