mother's critical condition with 20% of heart functioning

[sony999]

hello
my mother has a history of breast cancer. she was operated in 2007 and the lump from her right breast was removed. she was given a cycle of 6 chemotherapies and radiotherapy. we were told that about 50% of her heart is functional. however 5 years later the cancer reoccurred and this time it had spread to both the breasts. the doctors performed total mastectomy and gave her six cycles of chemotherapy again. she had pain in her feet, legs and fingertips. however her condition worsened when the feet started swelling and there were blue patches on both her feet. now the doctors tell us that only 20% of her heart is functional.
please help and suggest what should be the line of treatment from here. I am really worried for 20% is way too less from the required percentage. if possible also suggest us some good cardiac hospitals in India or abroad.

[sony999]

thank you so much for the answer. your advice is valuable and I am sure it will help us in the future.

[ed34]

Before the treatment was given, your Mother should have received heart tests to establish her heart condition. During treatment they should have been monitoring her heart to make sure too much damage was not occurring. This is important especially with the treatment of breast cancer because the location is very close to the heart. However, newer medications  seem to produce heart damage but often reverses, such as the drug trastuzumab. The problem is that radiation damages the DNA in cells, and this is how cancer is attacked to prevent its ability to multiply. Normal cells have a better chance of recovery because they multiply at a much slower rate. However, cardiac cells don't multiply but obviously the DNA is important for maintenance. It's basically a waiting game to see if any of those cells have the potential to repair, or if they have been damaged beyond repair permanently. When they say that 20% of her heart is functioning, this is meaningless. What you require for a better understanding it the LVEF percentage. This tells you how much blood is being ejected from the heart with each beat and gives a better idea of how well is it functioning. If the LVEF is 30% or higher then I wouldn't be too concerned at this stage but would concentrate on her recovery from the nasty ordeal of radiation treatment. There are many patients with an EF of 20% or less but in this case she would require monitoring to ensure it doesnt worsen. As long as she is getting adequate oxygen to her major organs, that's all that matters and this is achievable with 20%. If she does struggle to achieve the required blood flow around the body, then the Doctors should consider a LVAD which is a tiny pump that assists the heart. Others may argue with my opinion, but I believe the more she relaxes and takes things easy, the better the heart will recover with such circumstances. I am sorry I can't offer advice for a good heart hospital in India, because I am in the UK but I do really sympathize with your position and it's brilliant that you are looking out for your Mother. I will pray that you find the best solution for your situation.