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Enhanced external counterpulsation (EECP) is a valuable therapeutic option for patients with coronary artery disease and refractory angina.Although the exact mechanisms by which this technique exerts favorable effects remain unclear,improvement in endothelial function is considered a potential mechanism contributing to the clinical benefit associated with EECP.We describe a young woman with severely symptomatic coronary endothelial dysfunction in the absence of obstructive coronary artery disease who experienced a dramatic and sustained reduction in symptoms in response to a standard 35-hour course of EECP.