Breast Cancer Awareness Month

1. What is Breast Cancer?

A group of rapidly dividing cells that may form a lump or mass of extra tissue in the breast is called as breast cancer. Under normal circumstances majority of cells in the human body multiply in a regulated manner phasing out the old ones and replacing them with new normal cells.

Cancer is a group of diseases in which cells lose the ability to regulate their own growth and multiply out of control. Usually, cancer is named after the body part in which it originated; thus, breast cancer refers to the erratic growth and proliferation of cells that originate in the breast tissue.

2. What are the survival rates of breast cancer?

There are statistics available that sum up survival rates by breast cancer stage. The following are based on studies of a 5 year survival rate.

• Stage 0: 100%
• Stage I: 95%
• Stage IIA: 92%
• Stage IIB: 81%
• Stage IIIA: 67%
• Stage IIIB: 54%
• Stage IV: 20%

These statistics are from the American College of Surgeons National Cancer Data Base and are based on patients diagnosed from 1995-1998.

3. Am I at Risk of Breast Cancer?

Ideally both men and women can get breast cancer. But more than 99% of the cases occur in women. The greatest risk factors for developing breast cancer are the ‘FEMALE’ sex and increasing ‘AGE’.

People who think they may be at risk should discuss this with their doctor. Risk factors for breast cancer include the following:

• Older age.
• Menstruating at an early age.
• Older age at first birth or never having given birth.
• A personal history of breast cancer or benign (noncancer) breast disease.
• A mother or sister with breast cancer.
• Treatment with radiation therapy to the breast/chest.
• Breast tissue that is dense on a mammogram.
• Taking hormones such as estrogen and progesterone after menopause (not oral contraceptive pills).
• Drinking alcoholic beverages.

4. What are the tests available for detection and diagnosis breast cancer?

The simplest method of reaching a definitive diagnosis is by performing a “Triple Test”. A triple test includes a thorough Clinical Examination, a Fine Needle Aspiration Cytology (FNAC) or Core Biopsy (CB) of the lump and a Mammography (of both breasts). If all three of the afore-mentioned tests are suggestive of cancer, the accuracy of diagnosis is almost 100%. Two or more of the above, if suspicious for malignancy, mandate at least an excision biopsy (surgical removal of the lump) for histological confirmation of cancer or otherwise. Of the above, clinical examination carries maximum weight i.e. even if mammography and FNAC suggest benign pathology, a breast lump that feels clinically suspicious requires to be biopsied before declaring it benign.

A mammogram helps in many ways. It can detect impalpable lumps in the same breast or opposite breast and necessitate revision of the treatment plan. It can detect impalpable DCIS (seen as pleomorphic microcalcification) in the breast and can help in altering the decision to perform a breast conserving surgery in those patients. Contrary to wide-spread belief, the radiation emitted from a mammography machine is not harmful to patients.

5. If I get Breast Cancer how long will I live?

The greatest misconception that the common person has about cancer is that all patients eventually die of cancer. It is very important to realize that breast cancer is one of the most curable cancers in the human body. All patients who are cured live a normal life to their entire lifespan. As for those who relapse (recur), it is known that 90% of relapses occur within the first 3 years and after relapse the average survival is approximately 2 years.

6. What are the treatment options for a person suffering from breast Cancer?

Treatment of breast cancer involves a multidisciplinary approach. Patients suffering from breast cancer have the option of being treated by one or all of Surgery, Radiation Therapy (RT), Chemotherapy (CT), Hormonal Therapy (HT) and Biological Therapy (BT). The choice of treatment depends on the type and location of the cancer, whether the disease has spread, the patient’s age and general health, and other factors.

Surgery for breast cancer essentially includes two procedures; either modified radical mastectomy (MRM) or breast conservation therapy (BCT). A modified radical mastectomy (MRM) involves removal of the entire breast (with nipple and areola) along with the lymph nodes in the axilla. This treatment is reserved for patients with extensive disease (large tumours not responding to pre-operative chemotherapy) or patients with DCIS (which tends to be diffuse and involves the entire breast). The majority of patients (patients with small tumours or with large tumours downsized using pre-operative chemotherapy) undergo breast conservation therapy (BCT). BCT includes lumpectomy (removal of the breast lump with a 1 cm margin of normal breast around), axillary lymph-node dissection followed by radiotherapy to the entire breast with a boost to the lumpectomy site. This technique offers survival and relapse rates similar to a mastectomy, while at the same time preserving the breast which helps maintain the patient’s self-image, self-esteem and quality of life. Patients undergoing mastectomy also can be offered whole breast reconstruction that can be successfully performed using microvascular surgical techniques.

Radiation Therapy (RT) is given to all patients undergoing BCT to minimize chances of relapse in the remainder of the surgically untreated breast. However a few patients undergoing MRM also require to be treated with RT if the tumour is large (over 5 cm) or locally advanced or if more than three of the dissected axillary nodes harbour cancer. If RT is withheld in such patients there is a substantial risk that the disease will recur at the site of operation. The axilla (armpit) is not routinely radiated (except in certain circumstances) owing to the huge morbidity associated with it.

Apart from surgery and radiation therapy (both of which act locally) many patients also require treatment with agents that get distributed to all parts of the body via the blood circulation in order to tackle any microscopic disease that may be present there. This is called as systemic therapy. Systemic therapy is indicated in all patients who have established metastatic disease or in those who have a significant risk of relapse in distant organs (lungs, liver etc). In general, patients with tumours more than a couple of centimeters in size or with lymph nodes involved by disease have been shown to benefit after adjuvant systemic therapy. Systemic therapy can be provided using either cytotoxic chemotherapy (CT) or hormonal therapy (HT) or both sequentially. Standard CT protocols (first-line, second-line etc.) using a variety of chemotherapeutic drugs can be successfully administered to appropriate patients. Available evidence recommends a maximum of six cycles of chemotherapy per regimen or schedule. Hormonal therapy is beneficial only in a select group of patients whose tumors are hormone-receptor (Estrogen receptor or Progesterone receptor) positive. As part of hormonal therapy, a variety of drugs are available today, each with its own established indication. Ovarian ablation (by surgical removal or radiotherapy) can be considered as a line of hormonal treatment in premenopausal women above 40 years of age with hormone-receptor positive breast cancer. Temporary ovarian suppression (using injectable drugs given monthly for two years) can be offered to young patients with hormone-receptor positive early breast cancer who choose to maintain their fertility.

7. Can Breast Cancer happen to me only after 35yrs of age?

Not necessarily. One can have Breast Cancer even before that age but the chances are very slim. Internationally it has been seen that for over the last three decades the incidence rate has been stable in women under 50 years of age but is rapidly increasing over 50 years of age.

8. If my family member has BC does that mean I will also have it?

If any female relative in your family (including your grandmother, mother, aunt, sister, or daughter) has had breast cancer, you have a higher risk of getting it, too. Your risk doubles if the woman is your mother, sister, or daughter. And it’s even higher if your relative had cancer in both breasts or was diagnosed before she went through menopause. Research has shown that there is a genetic link between women in the same family who have breast cancer. If breast cancer runs in your family, you can have genetic testing to find out if you have that abnormal gene. If you do, you can explore options to help prevent the disease. But just because you have the abnormal gene doesn’t mean you’ll get breast cancer. Therefore, it’s best to have genetic counseling first to know whether or not to get tested and to know what to do following testing. Some women choose to have one or both breasts surgically removed. Another method of reducing the risk of developing breast cancer in such women is by performing a prophylactic bilateral oophorectomy (removal of ovaries) that reduces risk of developing both breast and ovarian cancer. Since surgery carries its own set of risks, talk about it with your doctor before making a decision.

9. What is screening for breast cancer?

Screening is the checking for the presence of breast cancer in order
to catch it early for treatment. Screening mammography has come in a big way in the west and has even been promoted as a perfect screening tool in our country. Over 88% of the female population within India is under 50 years of age (i.e. pre-menopausal) and we need to understand that the sensitivity of mammography in premenopausal patients, at best, is only 60%. This means that at least forty out of a hundred premenopausal women with breast cancer undergoing mammography will have normal mammograms and a false sense of security. Thus mammography cannot be considered as a screening method for all age groups in India. In postmenopausal women screening can be employed but definitely not in women less than 50 years of age (premenopausal). In our country breast self examination (performed monthly) and a clinical breast examination (performed annually) continue to be the best screening methods. However international screening recommendations mandate annual screening mammography for women over forty years of age.

10. What are the signs of breast cancer?

Breast cancer isn’t always detected with the naked eye. Its early signs are often hidden within your breast tissues. Changes to your breasts that you do see may not be the result of breast cancer at all. Lumps and bumps may come and go, as your hormones ebb and flow as you age. Breast skin may change texture due to sunburn, radiation treatments, or infections that cause rashes. So how would you know for sure whether or not a lump, skin rash, skin dimpling or nipple discharge is benign or cancerous? Sometimes a small tumor in the breast gets diagnosed after picking out a node in the armpit. You will need help from your medical professionals to get a clear diagnosis.

11. At what Stage of cancer am I?

Staging is the process physicians use to assess the size and location of a patient’s cancer. Identifying the cancer stage is one of the most important factors in selecting treatment options. Several tests may be performed to help stage breast cancer including clinical breast exams, mammogram, biopsy, and certain imaging tests such as an isotope bone scan, CT scan of chest abdomen and pelvis and Liver function tests. These tests are not performed on every patient but only those who have extensive disease within the breast i.e. breast lump more than 5 cm or tumour involving skin or presence of large matted axillary or neck nodes.

12. What is special about KDAH? Why should I only visit KDAH and not any other hospital or clinic?

The Kokilaben Hospital Comprehensive Breast Care Unit is a dedicated service that has been created to specifically diagnose and treat the entire spectrum of conditions affecting the mammary gland. The breast unit has been designed on the guidelines laid down by the European Union Society of Mastology (EUSOMA) and is based on two fundamental principles – Evidence Based Medicine and Multidisciplinary Approach.

Evidence Based Medicine – Over the years a lot of research has been carried out in the field of breast diseases, both benign and malignant, spanning diagnosis to treatment. It is important for all clinicians to keep up with this vast reservoir of knowledge, understand it and translate it into practice guidelines that are applicable in day-to-day clinical practice. This is called evidence based medicine. At the Kokilaben Hospital, we follow the model of evidence based medicine so that our patients can receive the highest level of care in surgery, chemotherapy or radiotherapy that is prevalent in the world e.g. In the field of breast cancer management, the next step of individualizing treatment for each and every patient has already been taken using new molecular predictors of recurrence by techniques such as microarrays and RT-PCR. Such advances in technology have allowed us to quantify the risk of relapse for an individual patient and tailor her therapy accurately e.g. avoid chemotherapy in patients who are at low risks of relapse on these new assays. Such advances in management are practiced on a regular basis in the Breast unit at the Kokilaben Hospital.

Multidisciplinary Approach – The days of surgeons treating breast cancer patients on their own are long gone. Today, centers of excellence all over the world treat their patients based using multidisciplinary teams. With growing awareness about breast cancer more and more patients are being diagnosed in early stages and consequently cure rates have risen to up to 85 -90%. This has made post-treatment quality of life and rehabilitation very important and relevant in addition to treatment issues.

The Kokilaben Hospital Breast Unit Team – At the Kokilaben Hospital, the breast unit multidisciplinary team includes a

• Breast Surgeon (specializing in benign and malignant diseases of the breast) – Dr Mandar Nadkarni, Dr Archana Shetty
• Plastic Surgeon – Dr Quazi Ahmed
• Medical Oncologist – Dr Sandeep Goyle, Dr Imran Shaikh, Dr Sewanti Limaye
• Radiation Oncologist – Dr Kaustava Talapatra, Dr Pranav Chadha
• Breast Radiologist – Dr Sheffali Shah Sardar, Dr Jigna Rathod, Dr Rolly Choudhary
• Breast Pathologist – Dr Bijal Kulkarni, Dr Meenal Hastak, Dr Nevitha Athikari
• Psychologist/counselor – Ms Priyadarshini
• Psychiatrist – Dr Shaunak Ajinkya
• Rehabilitation Therapist (occupational and physiotherapist) – Dr Abhishek Srivastava
• Breast Nurses

Each member of the team is an expert in his/her line of specialty and being a team encourages healthy interaction amongst all members in making and executing therapeutic decisions for individual patients. The main purpose of multidisciplinary team is to impart the best possible ‘state of art’ care to the patient from diagnosis to treatment and even post-treatment rehabilitation.

Disclaimer:

Information is designed for educational purposes only. Any decisions should be made in conjunction with your physician or therapist. We will not be liable for any complications, injuries or other medical accidents arising from or in connection with, the use of or reliance upon, any information in this brochure.

For further information and Doctor Appointment

You may call the hospital number +91-22-30999999/30666666. A convenient appointment date and time will be given to you. You can visit the hospital website www.kokilabenhospital.com

What is Osteoporosis?

Osteoporosis causes a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis makes your bones abnormally porous bone that is compressible, like a sponge. This disorder of the skeleton weakens the bone and results in frequent fractures in the bones.

Normal bone is composed of protein, collagen, and calcium, all of which give bone its strength. Bones that are affected by osteoporosis can break with relatively minor injuries that normally would not cause a bone to fracture. The spine, hips, ribs, and wrists are common areas of bone fractures from osteoporosis.

Common Osteoporosis Symptoms

Treating osteoporosis at the earliest is the best way to prevent some of the more serious consequences, such as loss of height or bone breakages. However, don’t know they have weak bones until they’ve broken their hip, spine, or wrist.

Here are a few signs or symptoms of Osteoporosis:

• Loss of height.
• Fracture from a minor fall.
• Back or neck pain.
• Stooped posture or compression fracture.

What are the risk factors for osteoporosis?

Both men and women can get osteoporosis, but this condition is more common in women. Here are some common risk factors of Osteoporosis:

• Older age.
• Having low testosterone in men.
• Having low oestrogen in women.
• Taking certain medications that decrease hormone levels.
• Smoking cigarettes.
• Having a family history of osteoporosis.
• Excessive alcohol intake.
• Low physical activity.

How do you treat osteoporosis?

Treatment for osteoporosis includes medications to help build bone mass. The medications often have hormonal influences, stimulating or acting like estrogen in the body to encourage bone growth.

How to Prevent Osteoporosis?

Having strong bones is one of the most important things to help prevent Osteoporosis:

1. Get enough Calcium.

You must strive to hit the daily intake recommendation:

• 1,000 mg for women 50 and younger.
• 1,200 mg for women 51 and older.

Foods high in calcium include milk and dairy products, soya beans, green leafy vegetables, nuts etc. Have a well-balanced diet and if required, take a supplement for calcium. Consult a nutritionist if required.

2. Don’t Forget Vitamin D

Vitamin D helps your body absorb calcium and use it to strengthen your bones. When your skin is exposed to sunlight, your liver and kidneys help make vitamin D. If required take supplements too.

3. Protein is important for Bone Health

Protein is in every cell in your body, including your bones. Studies have shown that eating protein helps increase bone mineral density.

4. Exercise regularly

Exercise helps stimulate the cells responsible for building bones. To promote bone health, try doing weight-bearing and resistance exercises 3 or 4 days a week.

• Weight-bearing exercises focus on carrying the weight of your body against gravity. Walking is a great weight-bearing activity, as are running, dancing, aerobics, hiking and tennis.
• Resistance exercises use an opposing force, such as weights, an elastic band, or water, to strengthen your muscles and build bone. Having strong muscles and a good balance may also help you avoid falls or minimize injury.

5. Build healthy life habits

The choices you make, beginning as early as childhood, can affect your bone health in the future. To protect it, consider making the following adjustments to your lifestyle:

• Quit smoking.
• Limit alcohol consumption.
• Maintain a healthy weight.
• Eat a well-balanced diet.
• Stay active.

Are you concerned about your bone health? Do you think you may not be getting the recommended levels of calcium and vitamin D? Consult experts at our Osteoporosis Clinic to help prevent osteoporosis and treat it if you already have it. Please find below the link for more details: https://www.kokilabenhospital.com/departments/clinicsatkh/osteoporosisclinic.html

Are you excited about the festive season?

Are you already planning your Diwali parties?

Or are you worried about your ongoing diet plan?

Diwali – the festival of lights and joy, rituals and celebrations brings everyone together. The festive season means many dinners and parties and yes a lot of festive eating. The festive season tempts you with delicious mithais and desserts, crispy namkeens and other calorie-rich foods. Are you going to abstain from the festive treats? Or are you going to enjoy guilt-free this season?

We believe that moderation is the key. Celebrate your Diwali and enjoy everything in a limit. Here are a few healthy hacks to eat well this Diwali:

1. Don’t give in to your sweet tooth

Choose mithais and ladoos made with sugar substitutes or dates that are available in the market.

2. Make your mithais at home

Choose to make healthy mithais at home with no added artificial colours.

3. Stay hydrated

Drinking water at short intervals will leave you feeling full, preventing you from overeating.

4. Focus on fibre-rich food

Limit your intake of fried foods and foods made from refined ingredients. While at a party choose to have salad and stir-fried vegetables instead of fried snacks. Fibre leaves you feeling full without causing you to gain weight.

5. Snack before you go out

Eating a light meal at home ensures you don’t reach hungry at a party and start binge eating. This helps exercise self-control at parties.

6. Think before you drink

Diwali is synonymous with parties. Before you raise your glass, remember alcohol is made by fermenting sugar and starch, so being high on alcohol is equivalent to being high on sugars and calories. Drink alcohol in limit.

7. Watch your portion sizes

The sight of your favourite dishes can challenge even those most dedicated to their diets. If you can’t control what you eat, manage how much you consume. Start by choosing a small plate to serve yourself.

8. Avoid talking when you eat

Eating while chatting with family and friends makes you overeat too quickly. Also, chew slowly for five to ten times to allow the brain more time to recognise when you have eaten enough.

9. Exercise

Apart from controlling your food intake during the festive season, it is important to burn calories too. So don’t skip your workout. Take half-an-hour out to walk, jog or cycle every day as cardio is the quickest way to burn calories.

10. Make your snacks

Use whole flours like wheat, bajra, jowar instead of refined flours to make traditional family recipes. You can also bake your snacks instead of deep-frying them.

Are you hosting a Diwali Party?

Here are a few tips to cook healthy:

• Avoid using any processed foods.
• Use low-fat or skimmed milk to make desserts instead of full cream milk.
• Use healthy cooking methods like stir fry or baking instead of deep-frying.
• Replace sugar in mithais with dates, jaggery or any natural sweetener.

While we agree that Diwali means celebrations and indulgence one must not lose track of their fitness goals. This is especially true for patients suffering from diabetes, obesity and high cholesterol levels. Diwali comes for a few days but the havoc it may create in your health numbers may be detrimental for your health. Be attentive towards your food choices and balance your Diwali festivities.

Do you want a personalised diet plan for Diwali? Consult our expert nutritionists who can guide you with a complete diet plan for the festive season.

Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumour that can often be seen on an x-ray or felt as a lump. The tumour is malignant (cancer) if the cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Breast cancer occurs almost entirely in women, but men can get breast cancer, too.

Metastatic breast cancer is breast cancer that has spread beyond the breast and nearby lymph nodes to other organs in the body (most often the bones, lungs, liver or brain).

What are the risk factors for breast cancer?

The cause of breast cancer is still unknown, however the below factors can increase your risk of getting Breast Cancer:

1. Gender and age

The main risk factors for developing Breast Cancer are being a woman and getting older. More than 70 per cent of all breast cancers occur in women aged 50 years and over.

2. Previous history

Women who have previously had breast or ovarian cancer have an increased chance of developing breast cancer.

3. Family history

A woman’s risk of breast cancer is increased if one or more of her close relatives have been diagnosed with breast cancer. For example, if your mother or sister had breast cancer.

4. Being overweight

This is because body fat increases levels of the hormone oestrogen. Combining a balanced diet with regular exercise helps to maintain a healthy body weight.

5. Alcohol

Regularly drinking alcohol increases the risk of developing breast cancer. Limit your alcohol intake – if you don’t drink, don’t start. If you choose to drink, have no more than 2 standard drinks per day.

Reproductive and hormonal factors

• Menstruation and menopause – women who start their periods (menstruation) at a young age or who have menopause at a late age have an increased risk of breast cancer.
• Having children – the younger a woman is when she has children and the more children she has, the lower her risk of breast cancer.
• Breastfeeding – breastfeeding lowers the risk of developing breast cancer, probably because it reduces a woman’s total number of menstrual cycles. Breastfeeding for longer can also reduce a woman’s risk.
• Oral contraceptives – oral contraceptives (the Pill) cause a slight increase in breast cancer risk. However this risk gradually decreases after a woman stops taking them.
• Hormone replacement therapy (HRT) – women taking hormone replacement therapy (HRT) have an increased risk of developing breast cancer, particularly if they take the combined oestrogen/progesterone HRT.

Symptoms of Breast Cancer

In the early stages, Breast Cancer has no symptoms. As a tumour grows, you may notice these signs:

1. Lump in your breast or underarm.

A lump in your breast or underarm that doesn’t go away after your period. This is often the first symptom of breast cancer. Lumps associated with breast cancer are usually painless.

2. Swelling in the armpit, collarbone, or breast.

Swelling in your armpit or collarbone could mean breast cancer has spread to lymph nodes in that area. This swelling may come before you feel a lump, so let your doctor know if you notice it.

3. Pain or tenderness in your breast.

Although lumps are usually painless, pain or tenderness can be a sign of breast cancer.

4. A flat or indented area on your breast

This could be a tumour that you can’t see or feel.

5. Breast changes

You might notice a difference in the size, contour, texture, or temperature of your breast.

6. A change in your nipple

It could get dimpled, itch, burn, develop sores, pull inward or have a discharge.

Prevention

Treatments are getting better with each passing day and the awareness about this disease is also increasing. Here are a few ways to prevent Breast Cancer:

• Maintain an ideal body weight, prevent obesity.
• Being physically active for at least 30 minutes a day lowers your risk of Breast Cancer.
• Try to eat a lot of fruits and vegetables and keep alcohol at moderate levels.
• Quit smoking.
• Breastfeeding for a total of one year or more (combined for all children) lowers the risk of breast cancer.

Don’t Forget Screening

Regular Breast Cancer screening with mammography helps save lives. It helps detect cancer early when it’s most treatable. For most women, regular mammograms can begin at age 40, but specific recommendations vary by age and risk.

If you are age 40 – 44:

You can choose to begin yearly mammograms.

If you are age 45 – 54:

Mammograms are recommended every year.

If you are age 55 or over:

Mammograms are recommended every other year.

Breast Cancer Facts

• Men can also get breast cancer.
• A woman has about a one in eight chance of being diagnosed with breast cancer in her lifetime.
• Most women (about 8 out of 10) who get breast cancer do not have a family history of the disease
• But women who have close blood relatives with breast cancer have a higher risk.
• About 5 to 10 percent of breast cancers can be traced to specific, inherited gene mutations, such as the BRCA1 and BRCA2 gene mutations.
• Women often detect breast cancers themselves, so don’t underestimate the importance of a monthly breast self-exam.

Do you notice any unusual changes in your breast? Seek expert advice, meet our oncologists at our Comprehensive Breast Care Unit. Please find below link for the website:

https://www.kokilabenhospital.com/departments/clinicsatkh/breastclinic.html

What is heart failure?

When your heart is working less efficiently can’t pump enough blood that you need.

Your heart chambers respond to stretching to hold more blood to pump. This helps to keep blood moving but gradually the heart pumping deteriorates.

Your kidneys react to this by retaining more salt and water.

What are symptoms:-

Depending on severity of disease, one cane have mild, moderate or severe symptoms.

Fluid overload – As a result of fluid retention you develop swelling in ankles and legs (called edema). This leads to bloating of stomach and loss of appetite.

Fatigue and weakness – less blood and flow to your muscle can cause fatigue and weakness. Less blood to brain may lead to dizziness.

Causes:-

Heart attack, high blood pressure, diabetes, atrial fibrillation (fast heart beat) disease of valves of heart, disease of heart muscle – (cardiomyopathy), congenital heart defects.

Smoking by causing heart attack leads to heart failure.

Diagnosis:-

Diagnosis of heart failure is based on clinical examination and few tests.

Blood test: For sugar, cholesterol, kidney and thyroid. Also NT-proBNP is blood test which help in diagnosis. Higher levels are seen in heart failure.

ECG: Shows heart rate and rhythm, chamber enlargement and electric conduction delay in heart.

Echocardiogram: This is sonography of heart and is most important test. It gives complete interaction of heart pumping, heart valves and is most important tool for diagnosis as well as to seen response to treatment.

X-ray chest: Gives information of water build up in lungs and size of heart.

Treatment:-

Three important medications to improve heart pumping are betablocker, ACE inhibiter / ARB / ARNI and third is Aldosterone Antagonist.

Unfortunately majority of patients do not get target dose of these drugs.

Diuretics are used to reduce fluid retention.

Newer Antidiabetic drugs like SGLT2 inhibitor also gives lot of benefits to patient with heart failure even if they don’t have diabetes.

Correction of iron deficiency also improve outcome of heart failure patients.

Diet:-

Salt restriction of less than 1500 mg previous day is important way to manage heart failure.

When to report to Doctor / A & E:-

• If weight gain more than 2 kg in week,
• Increasing swelling of ankle, feet,
• Worsening of breathlessness,
• Feeling tired or harder time to do daily activity,
• Fast heart beat or palpitations,
• Decrease urine frequency and quantity,
• Dizziness, loss of appetite.

Advanced treatment:

Some candidates with heart failure are candidates of special procedures and surgery.

• CRT (Cardiac resynchronisation) It is type of pacemaker which helps to improve heart pumping.
• ICD (Intracardiac defibrillation) Some heart failure patient may require ICD, to prevent and treat cardiac arrest. It is also a type of pacemaker.
• Heart valve surgery for affected valves.
• Heart transplant for advanced heart failure, not responding to all treatment options.