Freuently Asked Questions

  • Chronic chest pain (Refractory Angina) even after Bypass surgery or Angioplasty.
  •  Having 70 % -100 % blockages in angiogram
  •  Re-blocks after Bypass surgery or Angioplasty
  •  Chronic Renal disease with heart arteries block
  •  High risk cases medically unfit for Bypass surgery/angioplasty
  •  Patients’ coronary anatomy not readily amenable for Bypass surgery
  •  Inability to perform angioplasty because the target lesion is inaccessible/ diffuse
  •  Patients not willing for surgical procedures/ angioplasty.
  • Patient would have no angina.
  • Episodes of angina would be less.
  • Patient need for anti anginal medications can be reduced/stopped.
  • Patient can return to work and can participate in their active life style once again.
  • Patient would be more energetic and confident and walk more distance without chest pain.
  • Currently in use in outpatient facilities around the world.
During the treatment, the patient lies on a table. Echocardiography Imaging is performed to ensure precise applicator positioning. Focussed Low-Energy Shockwaves are then applied non invasively. This will create collaterals and improve blood flow to the targeted portions of the heart muscle.

The whole treatment duration is 20-30 minutes and the patient should undergo a series of nine treatment sessions during a nine week period.(3 treatments at first week of each month- 1st week , 5th week, 9th week). At each treatment session shockwaves are delivered under echocardiographic guidance.


ESMR has been proven to alleviate symptoms in 90% of patients. Studies have shown that improved blood perfusion to the heart muscle were only evident in the specific regions of the heart where shock waves were administered. Smokers and diabetic patients might need additional sessions to achieve therapeutic effect. To know more go to clinical data


During the treatment you might feel a local tickling/warmth in the treatment area.

There is no pain that the patient experiences during the treatment.
Can I go back to normal routine after the treatment?
Patient should take it light for immediately post treatment.


Unlike Bypass surgery, Angioplasty and stenting procedures, ESMR is non-invasive, carries no risk, painless, no anaesthesia or sedatives required, and is an outpatient procedure.
Ischemic myocardial areas no longer accessible by conventional revascularization therapies like Bypass surgery or Balloon Angioplasty and stent, could be treated with the ESMR therapy to relieve symptoms resulting from the myocardial ischemia.

No acute or long term side effects were reported.
Blockages or CHD is a disease in which a waxy substance called plaque builds up inside the coronary arteries. The plaques are more often seen when bad fats are more in the blood. These are the arteries which supply oxygen-rich blood to your heart muscles.

Over time, plaque can harden or break open. Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina .

If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack.

Angiography can be done to detect these blockages

Angiogenesis or Neo-vascularisation means formation or growth of new blood vessels (otherwise called coronary collateral formation) naturally which in turn increases the blood supply to the ischemic of the heart and improves the myocardial perfusion. Hence coronary collateral angiogenesis can also be called NATURAL BYPASS.

Shock waves are a kind of sound waves (like ultrasound) with high intensity and short duration. The sound waves are generated by an underwater high voltage spark, which are delivered non-invasively, focused by a special ellipsoid reflector. The reflector is coupled to the patient’s skin near the affected area with a water cushion. The focal zone distance into the patient’s body is adjusted according to the clinical requirements under 2d echo.


The purpose of this innovative non surgical treatment is to produce new pathways around the blocked arteries in Ischemic zone of the heart by expanding networks of tiny blood vessels called collaterals that help increase and normalize the blood flow to heart muscle thereby reducing or relieving angina.

ESMR treatment forms new natural blood vessels which improve the oxygenated blood supply to the affected portion of the heart non- surgically or non-pharmaceutically. For this reason it is called Non-Invasive or Non- surgical Bypass treatment or Non-Invasive Cardiac Angiogenesis therapy (Ni-Cath).
Shock wave technology is presently being used in the field of Urology for breaking Kidney stones and in Orthopaedics for bone and soft tissue injuries, and in dermatology for rejuvenation of skin, treating non healing ulcer and diabetic foot, and in sexology treating erectile dysfunction.