Case Reports   

Patient Case Reports

 NB: These are some of the case reports of cardiac patients who underwent treatment with Dr Mohanlall & Partners, trading as South African External Counterpulsation at 325 Umhlanga Rocks Drive, Umhlanga, Durban, KZN, South Africa.

1.   A 65 year old gentleman had undergone coronary artery bypass graft (CABG) surgery nine years ago. Despite undergoing a bypass and being on medical therapy, he continued to experience chest pain (angina CCS class 3) and shortness of breath (NYHA grade III). He was unable to walk up a flight of stairs to reach his post box without stopping to rest. He also suffered from hypertension and non-insulin dependent diabetes mellitus (type2 diabetes). His glucose levels however were not controlled. In addition, he also reported having a lack of energy and feeling tired, almost on a constant basis. After ECP therapy, he could walk up a flight of stairs without having to stop to catch his breath, and thus improved to NYHA grade I. He reported that his appetite had since improved, and that his blood glucose levels were well controlled. He is also now enjoying activities of leisure without tiring easily and ten months after his treatment he still reported feeling a general sense of well-being and more energized.

2.   A 69 year old male, experienced his first episode of a heart attack twenty four years ago and then underwent coronary artery bypass graft (CABG) surgery eighteen years ago. However, he developed a recurrence of chest pain two years after the bypass surgery, and investigations revealed triple vessel blockage of his coronary vessels yet again. He was told by his cardiologist that he was not a candidate for a second bypass and was placed on adjunctive medical therapy. He still experienced chest pain, and was classed as having angina CCS class 4 anginal symptoms. He also suffered from hypertension, non-insulin dependent diabetes mellitus (type 2 diabetes) and dyslipidaemia, for which he was on medication. His blood pressure and blood glucose levels however were still not controlled within normal parameters. Over the years, the chest pain did not cease and he suffered numerous heart attacks and admissions to hospital. He was told by his doctors that no further surgery could be performed on him, and that he had to continue with the maximum medical therapy he was given. He then decided to undergo ECP therapy in order to alleviate his symptoms and health status at the time. After ECP treatment, his blood pressure levels were controlled, and had decreased substantially. He no longer experienced chest pains and improved to CCS class 1 symptoms. His glucose levels were also within normal parameters and were more controlled.

3.   Mr 59 year old male, suffers from coronary artery disease. He suffered a heart attack in 2010, and was on medication. He also suffered from hypertension. Despite being on medical therapy, he still experienced recurrent episodes of chest pain and was diagnosed as having angina CCS class 2 symptoms. He often became short of breath on minimal exertion (NYHA grade IV).  The course of treatment decided by his cardiologist was that of maximizing his medical therapy and reviewing his health status again two months later for cardiac angiography with view of revascularization. He subsequently sought a second opinion from another cardiologist who suggested that he undergo ECP therapy. He agreed due to the non-invasive and cost-effective nature of ECP therapy. After completion of ECP therapy, he no longer experienced chest pains or shortness of breath. He improved to an angina CCS class 1 and NYHA grade I. His energy levels increased, and he was thus able to perform better at work. His echo report showed an increase in EF from 50% to 53%. An angiogram performed subsequent to ECP showed reversal of ischaemia in the posterior apical region of the heart.

4.   A 46 year old female, began experiencing recurrent episodes of tightness in her throat that radiated to the left side of her jaw, particularly on exertion (angina CCS class 3). The pain lasted for seven to ten minutes at a time, thereafter completely subsiding. She also experienced shortness of breath whilst walking up a flight of stairs (NYHA grade III).  Her blood pressure and heart rate levels were not controlled nor were they within normal parameters. She visited a cardiologist who diagnosed her as having angina symptoms and subsequently referred her for immediate cardiac angiography with view of revascularization.  Fearful of the invasive nature of angiography, she decided to try ECP instead. On commencement of treatment, her ECG showed findings of angina. On day 17 of treatment, she managed to walk the distance she did previously, at the same pace, without experiencing any pain. After ECP treatment, she reported having increased levels of energy, which afforded her completion of tasks that she could not previously carry out. Her blood pressure and heart rate levels became more controlled, and were sustained at normal levels.  Her ECG finding after treatment was normal. Several months after completion of ECP, She reported that she still had not experienced any episodes of pain or shortness of breath (NYHA grade I), and that her quality of life had improved remarkably.

5.   A 49 year old chartered accountant and businessman started experiencing symptoms of coronary artery disease 16 years ago. He subsequently visited his cardiologist, and underwent cardiac angiography. A stent was inserted into one of his coronary vessels and he was placed on medication. Seven years later, he experienced re-curing symptoms and thus underwent another cardiac angiogram which revealed a triple artery blockage. He then underwent coronary artery bypass graft procedure. A year ago he started experiencing a pain on the right side of his chest, particularly on exertion, and visited his cardiologist again. This time the test revealed no blockages. Even though a cardiac cause was ruled out, the pain persisted. He also suffers from hypertension, non-insulin dependent diabetes mellitus (type2 diabetes) and dyslipidaemia, for which he is on medication. He also felt a sense of chronic fatigue due to the demanding nature of his job. As a result, he tired easily at gym. He then learnt about EECP and he commenced treatment in the year 2010 at another ECP centre. After 35 treatments, he reported that there was no change in his health status. He then heard about South African External Counterpulsation who was also offering ECP treatment. He decided to give the treatment another try with our company. On commencement of therapy, his ECG findings showed changes that were concordant with a previous heart attack (ST segment depression). On day 7 of treatment, he reported being able to run up a flight of stairs without experiencing any chest pain or discomfort. On day 18, he reported that he felt ‘”fit” and ran on the treadmill at the gym for a longer duration without tiring easily. He also had energy to prolong his gym session by lifting weights again without tiring. Four months after his treatment he reported to be able to run for 25 minutes on the treadmill. His blood pressure was normal and he still feels good.

6.   A 69 year old gentleman underwent coronary artery bypass surgery 5 years ago, shortly after experiencing a heart attack. He noticed that despite having undergone surgery and being on medical therapy for coronary artery disease and hypertension, he continued to experience symptoms of chest pain and shortness of breath on minimal exertion and while lying flat (NYHA grade II). He took TNT’s at least two to three times per week for the relief of his chest pain (angina CCS class 2 symptoms). He also suffered from non-insulin dependent diabetes mellitus (type2 diabetes) which was also treated by oral medication. He decided to undergo ECP treatment after the advice of a family member who was in the medical field. On day 16 of treatment, he reported a marked reduction in the frequency of his symptoms on minimal exertion. He could now walk for longer distances, and a longer duration of time. He could also lie flat on the bed without having to use many pillows in order to prop himself up and catch his breath (NYHA grade I). On day 35 of treatment, he reported using TNT for a total of four times and that he felt healthier and more energetic.

7.   A 44 year old gentleman suffers from coronary artery disease. He recently started experiencing severe chest pain on minimal exertion, and sometimes at rest (angina CCS class 4), which occurred numerous times on a daily basis. The chest pains required him to take four to five TNT’s a day, in order for the pain to subside. He had three pillow orthopnea (NYHA grade IV). He visited a cardiologist, who referred him immediately for cardiac angiography with view of revascularization. He heard about ECP therapy, and decided to undergo treatment as he wanted to avoid the invasive nature of cardiac angiography. On his first day upon arrival for ECP treatment, he suffered a heart attack and had to be stabilised by the ECP team. On day 8 of treatment, he reported a significant decrease in the occurrence of chest pain (angina CCS class 1) and he was relieved that he could sleep comfortably with 2 pillows at night without having any difficulty in breathing (NYHA grade I). During the latter part of the treatment he was sleeping on one pillow again and reported to be doing much better at work as well. He was glad to be able to continue with his fishing hobby again.

8.   A 59 year old male, suffered from coronary artery disease and had three heart attacks thus far. After the last heart attack, he underwent cardiac angiography, which showed triple coronary vessel blockage. He was then immediately booked to undergo a coronary artery bypass graft (CABG). However the only available date at a state hospital was months later. He also suffered from hypertension, non-insulin dependent diabetes mellitus (type2 diabetes) and hypercholesterolaemia, for which he was on oral medication. Whilst awaiting surgery he read about ECP and decided to give it a try. On commencement of treatment, his blood glucose level was 6.6mmol/L and his blood pressure was controlled at 123/75mmHg. On his own accord, he decided to discontinue all oral medication. On the third day of treatment, his blood glucose level decreased to 5.8 mmol/L and remained around these levels for the duration of his treatment. During the latter part of his treatment he reported a loss of 4kg in his body mass. He could walk a distance of 2.5 km at least three times a week without a need for TNT’s. Thus he improved from an angina CCS class 3 anginal symptoms to CCS class 2.

9.   A 49 year old gentleman, suffers from coronary artery disease, and has had two previous heart attacks. After the last heart attack, he underwent coronary angiography which revealed a double vessel blockage and subsequently underwent a coronary artery bypass procedure four years ago. He also suffers from hypertension and type 2 diabetes mellitus, for which he is on oral medication. He experienced chest pain on exertion.  He also suffered from chronic fatigue and generalised body pains. His right ear was also blocked which impaired his hearing levels. He heard about ECP from his boss at work, who decided to send him for the treatment. After four sessions of ECP, he reported having increased energy levels and a marked improvement in his ability to cope with stressful situations that arose from work. His body pains had altogether disappeared. By day seven of treatment, he reported that his ear unblocked after years and his hearing has therefore improved.

10.   A 65 year old male, suffers from coronary artery disease. He suffered two previous heart attacks, the last one being just eight months ago. He had recurrent episodes of chest pain (angina CCS class 3) and shortness of breath, even on minimal exertion. He also indicated that he could not walk up a flight of stairs without experiencing significant shortness of breath (NYHA grade III). After the last episode of a heart attack, he was told to continue with his oral medication and he was referred for cardiac angiography with view of revascularization. He also suffers from non-insulin dependent diabetes mellitus (type2 diabetes) and dyslipidaemia for which he is on oral medication. On day 6 of treatment, he reported being able to walk up a flight of stairs without becoming breathless (NYHA grade I). He had not experienced any symptoms of chest pain. By day 28 of the treatment he reported increased energy levels allowing him to perform his work more effectively, with no chest pains. Four months after completion of his treatment he reported still keeping well with normal blood pressure and a glucose reading of 7.5mmol/L without taking any glucose tablets or insulin.

11.   A 45 year old male, is an established coronary artery disease patient, who underwent angiography and had 2 stents inserted subsequently in 2008. He is being managed on medical therapy. He still however experiences chest pain occasionally, at rest (CCS class 4). He also has co-morbid hypertension and dyslipidaemia for which he is being managed on medical therapy. He read about ECP in the newspaper and decided to undergo treatment in order to prevent worsening of his condition, which could ultimately result in coronary artery bypass graft surgery, and to alleviate his symptoms. After 10 treatments, he reported a remarkable increase in his energy levels and an improvement in his general well-being. After 20, treatments of ECP, his chest pains had resolved completely.

12.   A 58 year old gentleman is a post-bypass patient of 18 years. He suffers from dyslipidaemia and hypertension. He is on medical therapy for all of his chronic conditions. He experiences chest pain (angina CCS class 2 symptoms), shortness of breath on exertion (NYHA grade II) and chronic fatigue. A visit to his cardiologist recently revealed that surgery is not an option any longer and he was advised to consider heart transplantation as a last resort. He therefore decided to undergo ECP to alleviate his symptoms. After three treatment sessions, he reported having raised energy levels, so much so that he was able to get more done on a daily basis. An uncomfortable itchy sensation on his left leg which had been present for a while had also disappeared. His chest pain also disappeared. On week two of the treatment he reported feeling fit while completing tasks that used to tire him out on exertion. He also used to feel a sensation of numbness on his finger tips that have stopped completely since he started the ECP treatment. He has since gained a sense of well-being.

13.   A 60 year old established coronary artery disease patient who underwent coronary artery bypass surgery four years ago after experiencing a heart attack. However, he continued to experience symptoms of chest pain, which subsequently resulted in the insertion of 2 stents. He was maintained on medical therapy for his condition, and still continued to experience chest discomfort on maximal exertion (CCS class 2). He also suffers from hypertension, type 2 diabetes and dyslipidaemia, for which he is managed on medical therapy. He decided to undergo ECP in order to improve his health status. After two sessions of ECP, he felt a noticeable change in the duration and quality of his sleep. He no longer awoke at night, and felt refreshed the following day. His chest pain also resolved completely. He also suffered with continuous lower back pain, which altogether disappeared after commencing treatment. His energy levels rose considerably which enabled him to get more tasks done in a day. His overall health has since improved.

14.   A 57 year old male, is an established coronary artery disease patient. He has a history of chest pain (CC Class 3), which resulted in him having to undergo an angiogram and subsequently had a stent inserted. Due to the ongoing chest pain, a repeat angiogram a year later revealed no other blockages. He is currently being managed on medical therapy. He also suffers from type 2 diabetes mellitus and dyslipidaemia, for which he is being managed on medical therapy. He concurrently suffers from anxiety, and is on a sedative. He heard about ECP from a friend, and decided to undergo treatment in order to alleviate his symptoms. After 15 treatments, he reported an increase in his energy levels and felt as if he had more vigour. His chest pain subsided. His skin tone also improved. At the end of treatment, he felt an evident transformation in himself and his life and he has gained a sense of wellbeing.

15.   A 75 year old male suffered from tiredness which occurred on a continuous basis. He also felt short of breath, particularly on mild exertion (NYHA III). He decided to undergo ECP therapy in an attempt to alleviate his symptoms. After 20 treatments of ECP, he noticed an improvement in breathing, especially when walking long distances. He also felt at ease when climbing stairs and he experienced no sensation of breathlessness (NYHA I).

16.   A 65 year old women, is a known coronary artery disease patient. She suffered from chest pains of an angina nature (CCS class 4), on a continuous basis for which she had to take medication for immediate relief. She is also breathless on minimal exertion (NYHA III) and often found climbing up a flight of stairs difficult. An angiogram three months prior to commencing treatment revealed triple vessel blockage, but due to financial constraints in the government sector, she was placed on the waiting list for percutaneous coronary intervention and not a bypass graft. She also suffers from dyslipidaemia, type 2 diabetes mellitus and hypertension, for which she is on medical therapy. She decided to commence ECP treatment in an attempt to alleviate her symptoms. Her energy levels have increased after commencing treatment. She has less frequent episodes of chest pain which now occur on maximal exertion (CCS Class 2). The severity of dyspnoea has improved (NYHA II) ECG changes were also observed with particular improvement in the ST segment.

17.   A 56 year old male, is a known coronary artery disease patient. He began experiencing angina pains nine years ago, and subsequently had to undergo a stent insertion. Due to the persistence of his symptoms (i.e. chest pains) he had to undergo coronary artery bypass graft (CABG) surgery a year later.  Despite undergoing such procedures and being on maximal medical therapy, he has ongoing chest pains that radiate to his left arm at rest (CCS class 4). He is also an established type 2 diabetic, with co-morbid hypertension and dyslipidaemia. He is on oral medical therapy as well as insulin therapy for these conditions. He has a history of a thrombotic cerebrovascular attack (left sided) which occurred nineteen years ago. As a result, he has a fixed flexion deformity of his left knee. Three years ago, he was diagnosed with Parkinson’s disease, but is not being managed on medical therapy for this condition. He also suffers from erectile dysfunction for the past five years. ECP was recommended to him by a friend. After 15 treatments he felt a marked improvement in his symptoms of erectile dysfunction. After 18 treatments he reported that he could walk up stairs with ease and does not stagger as much as before. His chest pain has also improved (CCS Class 1).

18. A 41 year old gentleman with no known illnesses decided to undergo ECP treatment in order to improve his health status and as a prophylactic measure for further illnesses. At the end of the treatment, he reported having increased energy levels which allowed him to carry out more tasks in a day. He was thoroughly impressed with ECP.

19. A 63 year old male, suffered from coronary artery disease and had a stent inserted eighteen years ago. A repeat angiogram in 2010 revealed that he was not a candidate for coronary artery bypass graft procedure (CABG). He was on oral medication. He also suffered from hypertension, non-insulin dependent diabetes mellitus (type 2 diabetes) and dyslipidaemia, for which he was managed on oral medication. He suffered from chest pains which occurred on mild exertion and at rest, particularly when he lay down (angina CCS class II). He decided to undergo ECP in order to alleviate his symptoms and improve his health status. He found that he was able to walk up and down stairs and walk for longer distances with no occurrence of chest pain. The chest pain he experienced whilst he lay down also occurred less frequently and was milder in severity (angina CCS class I). He could now carry out his activities of leisure with ease.

20. A 54 year old male, suffered from non-insulin dependent diabetes mellitus (type 2 diabetes), hypertension and dyslipidaemia, all of which were managed on oral medication. Due to long working hours and late nights, he began feeling fatigued and low on energy. He visited his cardiologist who performed blood tests and a stress ECG. Blood tests revealed poor glucose control as well as a positive stress test on ECG. He was then referred for an angiogram. Upon hearing about ECP treatment, he decided to undergo ECP as an option to avoid angiography and improve his health status. After the first session of ECP, he felt a marked increase in his energy levels. A nagging back pain that was present before commencement of treatment, had subsided. At the end of ECP, he reported that his blood glucose levels were controlled within normal parameters and that his energy levels were still raised. He no longer felt tired and drained during the day.

21. A 56 year old female was a known coronary artery disease patient, who also suffered from hypertension and non-insulin dependent diabetes mellitus (type 2 diabetes). She was managed on oral medication for all illnesses as well as insulin therapy for her diabetes. She experienced symptoms of marked chest pain and breathlessness (NYHA III) on minor exertion e.g. bathing, washing clothes, climbing stairs, walking short distances. She often awoke at night as she would experience chest pain and would require the use of TNTs (angina CCS class) She took 6-8 TNT’s daily in order to relieve her recurrent chest pain. A recent angiogram revealed multiple blocked coronary arteries. However, she was not a candidate for percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Her daughter read about the role of ECP in the treatment of cardiac patients and thus she decided to undergo treatment as a last resort to improve her symptoms. On the 4th day of treatment, the frequency of chest pain decreased, and she took 2-3 TNT’s daily. At the end of ECP treatment, she had no occurrence of chest pain or breathlessness on exertion (NYHA I) and could carry out the tasks she couldn’t before with ease, i.e. bathing, household chores and climbing stairs. She walked for longer distances without feeling tired or having any chest pain. She also slept well at night due to the absence of chest pain. She no longer required the use of TNTs. She also felt more energetic in the day which aided in the ease with which she coped with her daily activities.

22.  A 68 year old male was a known coronary artery disease patient who underwent coronary artery bypass surgery four years prior. However, he still suffered from symptoms of breathlessness (NYHA III) and chest pain (CCS class 3) which began two years ago. He also suffered from hypertension, non-insulin dependent diabetes mellitus (type 2 diabetes) as well as dyslipidaemia, all of which were managed on oral medication. He visited his cardiologist who then adjusted his medication and he found some relief thereafter. He however still experienced occasional chest pains (CCS class 2) and had to catch his breath at gym when changing exercise machines (NYHA II).  He decided to undergo ECP to improve his health status. By the 7th treatment, he no longer felt breathless at the gym (NYHA I). After the 12th session of ECP, he reported feeling more energetic and lively during the day. He slept better at night and no longer awoke at odd times.  As the treatment progressed, he gained weight and started to feel sluggish and fatigued. It was later revealed that he was on a protein supplement which led to his weight problems. Towards the latter part of the treatment, he went on a diet recommended by SAECP and subsequently lost 5kg of weight and felt better.

23. A 65 year old male suffered from coronary artery disease. He had an angiogram performed in the year 2000 with two stents subsequently inserted. He then had a repeat angiogram done in 2003 with one of the two stents being unsuccessful. He experienced symptoms of slight chest pain radiating to his left arm on mild exertion (angina CCS class 1). He also felt tired after climbing stairs and sometimes after a bath. He suffered from co-morbid hypertension which was managed on oral medical therapy. Due to an injury to his left ankle he often suffered from swelling and pain of his left ankle. He learnt about ECP from a newspaper advert and decided to try it to improve his symptoms. Due to a diet recommended by SAECP, he experienced significant weight loss during the course of ECP treatment. The chest pain that radiated to his left arm had also subsided. He was able to walk for longer distances without being tired. He was not as tired during the day as he was previously. The swelling and pain in the left ankle that he previously experienced had improved. Also to note, the discolouration over his left foot improved and there was a noticeable change in his generalised skin tone.

24. A 75 year old male was a known coronary artery disease patient who began experiencing chest pains eight years ago. A subsequent angiogram revealed vessel blockage, with one of two stents being successfully inserted. A repeat angiogram two and a half years ago was performed as he began experiencing severe chest pains. No stents were inserted and no angioplasty was performed. He still experienced chest pain on activities such as walking up stairs or walking up and down his driveway as well as whilst gardening (angina CCS class 3). He had to take TNT on such occasions (usually 2 TNTs per day) and felt relief after five minutes. He also felt breathless whilst walking at a faster pace (NYHA II) and could only walk a distance of a kilometre at a slow pace. He suffered from co-morbid hypertension and dyslipidaemia, for which he was managed on oral medical therapy. He read about ECP in a newspaper article and decided to undergo treatment in an attempt to alleviate his symptoms. By the 9th day of treatment, he could walk up and down his driveway without experiencing any chest pain or breathlessness (NYHA I) and thus did not require the use of TNTs. He also managed to carry weights in the form of bricks up and down the driveway without tiring or experiencing chest pain. He managed to walk up flights of stairs without experiencing chest pain or breathlessness. There was also a sustained decrease in his blood pressure levels during treatment. Half way through ECP treatment, he reported his skin tone to be improved and looked more youthful.  A dark discolouration on both his hands disappeared after ECP without the aid of prescribed creams.

25. A 72 year old female suffered from coronary artery disease. An angiogram was performed thirteen years ago with two stents being inserted. She experienced breathlessness on exertion and occasionally while asleep (NYHA IV) as well as chest pains on exertion (CCS class II). She suffered from co-morbid hypertension and dyslipdaemia for which she was managed on oral medical therapy. She learnt about ECP therapy from a newspaper article and decided to try this form of treatment in order to alleviate her symptoms. At the commencement of therapy, she had many ectopic heart beats. However, by the 14th day of treatment, the ectopic heart beats had disappeared and her heart beat became regular. She no longer felt breathless (NYHA I) nor did she experience any chest pain, and could walk for longer distances. She felt more energetic during the day. Despite the reduction in dosage of her beta blocker by half during treatment, her heart rate was stable within normal parameters.  

26. A 66 year old male suffered from coronary artery disease. He suffered a heart attack six years ago. He was thereafter managed on oral medication. Recently however, he once again began experiencing chest pain on exertion and at night (angina CCS class 4), which were alleviated with the use of TNTs. His chest pains occurred on a daily basis and thus required the use of TNTs daily. He also felt tired during the day and after certain activities such as showering and walking for short distances. He suffered from co-morbid hypertension, non-insulin dependent diabetes mellitus (type 2 diabetes) and dyslipidaemia, all of which were managed on oral medical therapy. He learnt about ECP in a newspaper advertisement and decided to undergo treatment in an attempt to alleviate his symptoms. At the commencement of therapy, he had numerous ectopic heart beats. However, by day 6 of ECP treatment, the ectopic heart beats were markedly decreased. After 10 ECP sessions, he reported that the frequency of his chest pains had decreased and he had a reduced need for TNTs (Angina CCS grade 1). He experienced only two episodes of chest pain throughout ECP treatment, which lasted about two minutes with TNT usage. He walked for longer distances without experiencing chest pain or having to rest because of tiredness. He also slept well at night without any occurrence of chest pain. His energy levels had increased and he no longer felt tired during the day and after activities. His appetite also improved during the course of the treatment. His glucose levels were also well maintained during the course of the treatment.

27.  A 60 year old male was a known coronary artery disease patient who had a coronary artery bypass graft surgery (CABG) ten years ago. A repeat angiogram was performed in 2011 with a stent subsequently inserted. He was managed on oral medical therapy. In 2010, he underwent an aorto-bifemoral bypass due to impediment of blood flow in his legs. He also suffered a mild stroke eight years ago. He suffered from co-morbid hypertension, non-insulin dependent diabetes mellitus (type 2 diabetes) and dyslipidaemia all of which were managed on oral medication. He experienced an intense pain in both legs, particularly on exertion. The pain resulted in a restriction of activities such as walking for long distances. He was referred for ECP treatment by his brother who was undergoing treatment at that time. During treatment he gained power in his left foot and could fit his shoe onto his foot without the aid of his hands. He was placed on a protein supplement in order to build muscle in his legs. He experienced less pain in his legs on exertion. He felt less tired during his two week holiday period. He was able to work in the garden at ease, and began driving more often.

28. A 60 year old male was a known coronary artery disease patient who underwent a coronary artery bypass graft (CABG) procedure 10 months prior to beginning ECP treatment. Shortly after his bypass procedure, he began experiencing chest pain on exertion (angina CCS class 3), shortness of breath (NYHA III) and tiredness. He could not walk for long distances or walk up stairs without experiencing these symptoms. He also could not drive as he would experience chest pain whilst driving. He visited his cardiologist who performed an ECG stress test that turned out to be positive. He was then referred for a coronary angiogram. However, the coronary angiogram could not be performed as blood tests revealed abnormal renal function. He then decided to undergo ECP in order to alleviate his symptoms and improve his quality of life. On day 17 of treatment, he managed to walk to and from the clinic in his residential area without experiencing chest pain or shortness of breath (NYHA I). As the treatment continued, he noticed that he could walk for a longer distance (1.5km) whilst carrying groceries. He began climbing flights of stairs without experiencing symptoms. He did however experience some tiredness during these activities, but it was not significant enough to precipitate other symptoms or stop the activity. He began driving with ease. He started feeling energetic during the treatment and no longer felt drained and tired. He also no longer suffered from generalised body pains. His fasting glucose levels were maintained around 8mmol/l at the end of treatment.

A 57 year old male was a known coronary artery disease patient. He suffered a myocardial infarction in 2011 and subsequently underwent Coronary Artery Bypass Graft (CABG) surgery. After the surgery, he began exercising daily in the form of walking for 5km and also visited the gym three times weekly. However, eight months after the surgery, he began to feel breathless whilst walking in the evenings (NYHA II) and he could only walk for 1km. A visit to the cardiologist resulted in a stress ECG and echocardiography. The ECG stress test showed no abnormalities but the patient was breathless (no chest pain experienced). Echocardiography showed septal hypokinesis and wall thickening, with an ejection fraction of 65% at rest and 72% during stress. He was referred for ECP by his cardiologist who thought that ECP would aid in alleviating his symptoms. By day 10 of ECP, he reported to have increased energy levels and no longer felt tired during the day. On day 12 of ECP, he was able to walk 2km without becoming short of breath as he did before (NYHA I). After 25 days of ECP treatments he managed to jog without experiencing any symptoms. He also began weight training and planned to return to gym after the completion of ECP.