Can you talk about what we saw in the other room?
Dr. Kronhaus: The patient comes in and lies on a comfortable bed and we put three blood pressure cuffs on each leg. We put a calf a lower thigh and an upper thigh cuff on each leg. Using air pumps, the cuffs are blown up to contract and then allowed to release. But the magic of EECP is that the compression and release of the six blood pressure cuffs are timed to the cycle of the heart. The machine is a smart machine it knows when your heart relaxes and it knows when it contracts. The heart gets its blood flow when the heart relaxes and when the heart goes in to its most extensive relaxation state these six blood pressure cuffs milk the blood in the arteries and the veins back to the heart. So you have an upper (systolic) and a lower (diastolic) blood pressure number and the lower blood pressure number is increased briefly by the increased blood flow return from the arteries and veins of the legs. When the heart fully relaxes you thus get increased blood flow to the heart. And then as the heart is about to contract all six-blood pressure cuffs magically together release. This is when the rest of the body gets its blood flow and is the result of the upper blood pressure. So actually the heart has less of a force to have to pump against and there is unloading of the heart. This cycle goes on with each heartbeat and the machine is triggered by ones own heartbeat.
Do you see any side affects after using the machine?
Dr. Kronhaus: We rarely see any side effects. Occasionally, we'll see some skin irritation but if the provider is careful and adequately protects the skin serious issues can be avoided. Our office has been providing this treatment since 2000. We have treated over a thousand patients and we never have seriously hurt anyone.
Can you talk a little bit about Connie and her situation?
Dr. Kronhaus: Connie is a registered nurse, she's fifty-three and she came to see me complaining of chest pain, unexplained fatigue and palpitations. She is an intuitive nurse, tried to diagnose herself and was so frustrated because she couldn't come up with a cause of her symptoms. And she had eliminated all of the obvious culprits. She came to me and I was concerned that given her age and her sex, and being a peri-menopausal female, that her symptoms suggested she had microvascular angina. What we did was we put her on the treadmill. We did an exercise stress echo and she had a very small area of inadequate blood flow. We call it ischemia. Instead of doing a heart catheterization, we did a CT angiogram of her coronaries and we were able to see the big coronaries giving the blood to her heart. The big coronaries, the epicardial coronaries, were wide open and five, ten, fifteen, twenty years ago the heart doctors would have said, Connie you're fine no problems. And she would have gone from doctor to doctor and ultimately probably ended up at the psychiatrist thinking that she was crazy. And I, unfortunately, have seen too many people treated like that before we recognized microvascular angina as a real diagnosis in the last five to ten years. There are three million heart catheterizations each year in America and one million are normal. We have been telling those one million they have no heart disease and a significant fraction of that one million have microvascular angina. They ping pong from doctor specialist to doctor specialist, no one ever finds their diagnosis and they usually end up on the psychiatrist couch. And I've had so many, many women and even some men come to me frustrated, we've diagnosed microvascular angina, we've treated them with EECP and it's even more effective for microvascular angina than it is for the big vessels. We see ninety to ninety five percent improved. Connie has had resolution of her chest pain, palpitations, and fatigue. We then did a stress test after her EECP was completed and her stress test now normalized.
Treating microvascular angina, can you do surgery for that?
Dr. Kronhaus: For microvascular angina you have limited options for treatment. About forty percent are able to get some benefit from medications but unfortunately most of the medications lower blood pressure and that becomes a limiting factor. But most don't get any benefit from the medications or from exercise and the vessels are much too tiny to even see. You can't see them on a routine heart catheterization so you can't stent them and you can't do invasive bypass surgery. The only effective option for so many who have microvascular angina is EECP.
You said pre-menopausal but is there something people should be looking at?
Dr. Kronhaus: I think if anybody has unexplained chest pain, shortness of breath, palpitations, unexplained fatigue, if you have any of those symptoms and the doctor can't diagnose the cause you have to think about microvascular angina. It's so common.
So Connie has had how many sessions?
Dr. Kronhaus: Connie two years ago, in the fall of 2009 had thirty-five one-hour treatments.
Why do you think a doctor is so quick to prescribe drugs instead of thinking of a therapy like EECP?
Dr. Kronhaus: I think doctors treat with what they're comfortable with and it's a reasonable first approach to try medications. We each have our own approach to the patients. Being on medications for life may have adverse affects so if you have a substitute, another option like EECP which will avoid any cutting, any needles and any medications, it seems to me that that's just a wonderful option. And in the long run it's going to be cost effective if you don't have the cost of lifelong drugs. And with microvascular angina there's only a small sub-group of people that won't get any benefit.
You are a cardiologist, you see a lot of patients, is there anything you do differently in your life that you didn't do before?
Dr. Kronhaus: Well I like to walk the walk. Everybody teases me because I do eat healthy, I try to watch the blood pressure, the blood sugar, the blood cholesterol, and I don't smoke. I try, it's a continuous effort, to maintain ideal body weight and I try to walk the walk. And so I have tried to live a heart healthy life.
Is there something specific, do you run three miles, what do you do?
Dr. Kronhaus: I'm a great believer that where I am in life it is best to "train and not strain." So I try to get some aerobic exercise every day. But not to the point where it is actually causes pain. I'm a great believer in mid life that "no pain no gain" can be dangerous. And also, it's a good idea to do weights three times a week on alternate days.
Is there anything you don't eat?
Dr. Kronhaus: Well I'm not crazy and exclusive, I'm a great believer in moderation but obviously most of my diet is fruits, vegetables, whole grains, low fat dairy products, beans, seeds, nuts, fish, turkey, and lean meats.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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Kenneth D. Kronhaus, MD
Cardiologist
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