EXHIBIT 4.3 ----------- CardioDynamics International Corporation 6175 Nancy Ridge Drive, Suite 300 San Diego, CA 92121 July 18, 2001 The Allen E. Paulson Living Trust c/o Paulson Enterprises P.O. Box 9660 Rancho Santa Fe, California 92067 Attention: J. Michael Paulson and Edward White Ladies and Gentlemen: Reference is made to a certain Securities Purchase Agreement dated as July 19, 2001 (the "Purchase Agreement"), pursuant to which the Trust has agreed to sell (the "Sale") up to one million five hundred thousand (1,500,000) shares of CardioDynamics International Corporation (the "Company") Common Stock (the "Shares") to Pine Ridge Financial Inc. (the "Purchasers"). As contemplated by the Purchase Agreement, the Company will enter into a Registration Rights Agreement dated as of July 19, 2001 (the "Rights Agreement") with the Purchasers, whereby the Company will agree to register the Shares for resale and keep such registration statement effective for a period of two (2) years, as more fully described in the Rights Agreement. The Company hereby agrees to use its best efforts to cause such registration statement to be declared effective within 90 days following the Closing Date as such term is defined in the Purchase Agreement. The Trust hereby agrees to reimburse the Company, out of escrow established in connection with the Purchase Agreement, for all of the Company's expenses (up to a maximum of $25,000 in the aggregate) that the Company incurs in connection with any registration, qualification and compliance requested pursuant to the Rights Agreement, including without limitation, all filing, registration and qualification, and accounting fees and the fees and disbursements of its counsel. Further, as compensation for (i) our introduction of the Purchasers to the Trust, (ii) fees and expenses we incurred in connection with such introduction, and (iii) the otherwise unreimbursed fees and expenses related to the registration of the Shares as well as the devotion of management time to and opportunity cost associated with preparation and review of the documents associated with the Sale and the registration and qualification of the Shares, the Trust hereby agrees to pay to the Company, in cash at the time of the Settlement Date of the Sale as set forth in the Purchase Agreement, a fee equal to three and one-half percent (3 1/2 %) of the gross purchase price paid by the Purchasers for the Shares. The Company shall refund the foregoing fee to the Trust in the event that the Trust is required to repurchase the Shares and does so repurchase such Shares from the Purchaser because the registration statement that the Company has agreed to file with respect to the Shares has not been declared effective within 90 days following the Closing Date. Please execute and return this letter agreement (which may be executed in counterparts) to the undersigned to concur that (i) this sets forth the Trust's complete and entire understanding with regards to the subjects described within, and (ii) that this letter agreement may not be amended or modified except in a writing executed on behalf of both the Company and the Trust. By execution hereof, we both further agree that this letter agreement is to be governed by and construed in accordance with the laws of the State of California, as applied to contracts among California residents, made and to be performed entirely within the State of California. CardioDynamics International Corporation a California corporation By: /s/Michael K. Perry -------------------------------- Name: Michael K. Perry Title: Chief Executive Officer Accepted and agreed as of July 19, 2001: The Allen E. Paulson Living Trust By: /s/ J. Michael Paulson --------------------------------------- Name: J. Michael Paulson, Co-Trustee By: /s/ Edward White --------------------------------------- Name: Edward White, Co-Trustee