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FRESNO, Calif.

Connie Crews has a very important job, she's a full time mom to dogs Casey and Marty. But while working her part time job as a nurse she realized something wasn't right with her heart.

" I noticed what I thought was heart burn.," Connie Crews told Ivanhoe. "With the burning, I would have some radiation, I would feel it radiate to the left side of my chest."

It was micro vascular angina or MVA, an early form of coronary heart disease that occurs when arteries narrow and the heart doesn't get enough oxygen rich blood. Cardiologist Doctor Ken Kronhaus says people with it have few options.

"The vessels are too tiny to put a stent in, they're too tiny to even see to think of doing surgery and the medications work much less than half the time," Kenneth D. Kronhaus, M.D., a medical director and cardiologist at Lake Cardiology in Orlando, Florida said.

To treat it, he's using a non-invasive treatment for heart patients, enhanced external counterpulsation or EECP.

"It milks the blood in the arteries and veins in the legs and increases the blood flow to the heart," Dr. Kronhaus said,

For seven weeks, patients lie on a bed for 35 one hour sessions. Blood pressure cuffs inflated with air are wrapped around each leg. They contract and expand with each heart beat helping develop better circulation.

"You actually get a mechanical angiogenesis, new blood vessel development in the heart without any needles, cutting or added medication," Dr. Kronhaus said.

EECP has few side effects and there's no recovery time. It's been proven to work in 95%of MVA patients. Doctor Kronhaus says the therapy could one day replace life-long heart drugs. After 6 weeks of treatment, Connie's medication free.

"I continue to feel better, to have more stamina and just have a better sense of well being," Connie said.

Doctor Kronhaus says MVA is most commonly seen in women who are peri- menopausal but it can also affect men. Researchers think the disease is caused by a drop in estrogen levels during menopause combined with traditional heart disease risk factors. The treatment could cost up to six thousand dollars but it's usually covered by insurance.

BACKGROUND: Angina pectoris is a Latin phrase that means "strangling in the chest". Patients often say that angina is like a squeezing, suffocating, or burning feeling in their chest, but an episode of angina is not a heart attack. The pain often happens after exercise. Unlike a heart attack, the muscle is not damaged forever, and usually goes away with rest. Angina is usually caused by coronary artery disease, CAD. The pain usually happens when a clogged or diseased vessel in the heart no longer delivers enough oxygen-rich blood to a part in the heart. Furthermore, Cardiac Syndrome X is related to microvascular angina. Cardiac Syndrome X is a condition where patients have the pain of angina, but they do not have CAD. Cardiac Syndrome X is more common in women, especially women who have gone through menopause. It is not life threatening and does not increase risk of CAD or heart attack. (www.texasheartinstitute.com)

CAUSES: The causes of microvascular angina are not fully known. Some doctors think it has to do with how the patient feels pain, while others think it may be linked to low levels of the female hormone estrogen. In microvascular angina, the small blood vessels in the heart, capillaries, tighten or constrict. This tightening reduces the blood flow in the heart and causes the pain of angina. However, since the capillaries are so tiny, they do not increase the risk of heart attack. (www.texasheartinstitute.com)

TREATMENT: EECP, Enhanced External Counterpulsation, is a non-invasive treatment that uses timed, sequential inflation of pressure cuffs on the calves, thighs and buttocks to augment diastolic pressure, decrease left ventricular after load, and increase deoxygenated blood return. Augmenting diastolic pressure displaces a volume of blood backward into the coronary arteries during diastole, a period of time the heart fills with blood, when the heart is in a state of relaxation and the resistance in the coronary arteries is at a minimum. The resulting increase in coronary artery perfusion pressure may enhance coronary collateral developmental or increase flow through existing collaterals, vessels. In addition, when the left ventricle contracts, it faces a reduced aortic pressure to work against since the counterpulsation has somewhat emptied the aorta. EECP has been primarily investigated as a treatment for chronic stable angina. (www.ncdhhs.gov; American Medical Association)

APPLICATION: Intra-aortic balloon counterpulsation is a more familiar, invasive form of counterpulsation that is used as a method of temporary circulatory assistance for the ischemic heart, often after an acute myocardial infarction. In contrast, EECP is thought to provide a permanent effect on the heart by enhancing the development of coronary collateral development. A full course of therapy usually consists of 35 one-hour treatments, which may be offered once or twice daily, usually five days per week. The multiple components of the procedure include use of the device itself, finger plethysmography to follow the blood flow, continuous electrocardiography to trigger inflation and deflation, and optimal use of pulse oximetry to measure oxygen saturation before and after treatment. (www.ncdhhs.gov; American Medical Association)

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