Ischemic heart disease that is refractory or resistant to medical management is a concern to health team members, patients, and their families. These patients are limited in their abilities to perform activities of daily living and often find it difficult to exercise which negatively affects their quality of life. Some patients are confined to bed rest due to these limitations. Enhanced external counterpulsation (EECP) is a noninvasive outpatient procedure that has been shown to improve the patient's quality of life by decreasing ischemic symptoms and permitting increased activity. This article reviews the basic principles of EECP therapy and identifies the goals and benefits for the patient. Helpful tips and observations are discussed as to the use of this treatment using evidence-based research.