Figure 1.

Enhanced external counterpulsation employs a series of 3 cuffs placed on the calves, lower thighs, and upper thighs/buttocks. The cuffs receive sequential distal-to-proximal pneumatic inflation upon onset of diastole, and simultaneous release of pressure at end-diastole. The hemodynamic result is increased retrograde aortic flow, increased venous return, and increased systolic unloading and cardiac output.