Enhanced external counterpulsation is a noninvasive technique designed to increase myocardial perfusion and reduce cardiac workload in patients with coronary artery disease. Recent trials have documented beneficial hemodynamic effects. Stress testing and radionuclide imaging have demonstrated improvements in functional capacity and myocardial perfusion. This procedure may be the therapeutic choice for patients with severe diffuse disease or in whom repeat revascularization is not possible. The relatively low cost of the technique makes it feasible for patients in developing countries.