Explorez tous les épisodes du podcast Cardiology Course FM
| Titre | Date | Durée | |
|---|---|---|---|
| Familial Hypercholesterolaemia, Dyslipidaemia, Lipoprotein(a), Homocysteine and Fibrinogen — Diagnosis and Management of Hidden Causes of Premature Coronary Disease | 21 oct. 2026 | 00:44:52 | |
Our 100th episode! Long before the first symptom, silent risk factors in the blood build coronary disease — often in young South Asians. In this masterclass Dr. A M Thirugnanam covers the diagnosis and management of familial hypercholesterolaemia, dyslipidaemia, lipoprotein(a), homocysteine and fibrinogen, and the patient with premature coronary disease and no obvious cause. Topics include why LDL is causal and "lower and earlier is better"; ESC targets by risk and Lipid Association of India targets; lipid therapy during the ACS admission and early combination therapy (2025 ESC/EAS focused update); practical laboratory points (non-fasting samples, Friedewald versus direct LDL); FH — genetics, prevalence, clinical signs, Dutch Lipid Clinic Network and Simon Broome criteria, genetic testing, cascade and childhood screening; treatment with high-intensity statins, ezetimibe, PCSK9 antibodies (FOURIER, ODYSSEY OUTCOMES) and inclisiran; homozygous FH — evinacumab, lomitapide, apheresis; FH and pregnancy; non-HDL cholesterol, apoB and secondary causes; atherogenic dyslipidaemia in South Asians; high triglycerides, pancreatitis, familial chylomicronaemia and APOC3 therapies, icosapent ethyl (REDUCE-IT) and PROMINENT; HDL-raising failures; Indian dietary advice; statin intolerance, the nocebo effect (SAMSON) and bempedoic acid (CLEAR Outcomes); monitoring, statins in the elderly and coronary calcium scoring; lipoprotein(a) — the 50 mg/dL threshold and the Lp(a)HORIZON pelacarsen result (September 2026); raised homocysteine — causes, B-vitamin trials, CSPPT, and classical homocystinuria; fibrinogen, hs-CRP, JUPITER and colchicine (COLCOT, LoDoCo2); and a systematic approach to "idiopathic" premature coronary disease, including thrombophilia, SCAD, spasm and anomalies. Cases: a 34-year-old with a heart attack from genetically confirmed FH whose diagnosis protected his sister and daughter, and a young man with thrombosis from missed homocystinuria. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| M-TEER and T-TEER: Mitral and Tricuspid Transcatheter Edge-to-Edge Repair — Patient Selection, Methods, Complications and Management | 21 oct. 2026 | 00:46:27 | |
Through a vein in the groin, a small clip grasps the leaflets of a leaking valve and holds them together. Transcatheter edge-to-edge repair of the mitral and tricuspid valves is changing the lives of patients once told nothing could be done. In this masterclass Dr. A M Thirugnanam, author of "Transcatheter Edge-to-Edge Repair of the Mitral and Tricuspid Valves", covers: primary versus secondary (ventricular and atrial) mitral regurgitation; comprehensive and 3D severity assessment; M-TEER for primary MR in high-risk patients (EVEREST II); the secondary MR evidence — COAPT, MITRA-FR, proportionate versus disproportionate MR, RESHAPE-HF2, and the 2025 ESC/EACTS class I recommendation; optimising GDMT and CRT first; atrial secondary MR; anatomical suitability (valve area, gradient, leaflet length, calcification, flail gap and width); pre-procedure work-up; MitraClip and PASCAL; step-by-step M-TEER — transseptal height and position, steering, alignment, grasping, leaflet insertion, residual MR, gradient and v-wave; TEER in acute post-MI MR with shock; tricuspid regurgitation — causes, lead-related TR, massive and torrential grades, late presentation; T-TEER evidence (TRILUMINATE Pivotal, Tri.fr, 2025 ESC class IIa) and transcatheter replacement (TRISCEND II); T-TEER selection, imaging with transgastric views and ICE, and technique; complications — single leaflet device attachment, leaflet tear, mitral stenosis, chordal entanglement, tamponade, air embolism, iatrogenic ASD, lead dislodgement and RV afterload; post-procedure care, durability, very elderly patients, options after failed TEER, building a TEER programme, and counselling. Cases: a COAPT-like ischaemic cardiomyopathy patient treated with two clips, an elderly woman with massive lead-associated TR treated with T-TEER, and a single leaflet device attachment rescued with a second device. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Cardiac Tumours — What They Are, How to Diagnose Them, Treatment and Management | 21 oct. 2026 | 00:44:22 | |
A mass in the left atrium causing fainting, a stroke in a young adult from a tiny growth on a heart valve, a recurrent pericardial effusion that turns out to be cancer — cardiac tumours are rare, but they test every clinical skill. In this masterclass Dr. A M Thirugnanam explains how to classify cardiac masses (primary benign, primary malignant, metastatic, and pseudo-tumours — with thrombus the commonest mass of all); the three classic presentations — obstruction, embolism and constitutional symptoms — plus arrhythmias, effusion and caval obstruction; examination clues, ECG, chest X-ray and blood tests; myxoma — location, tumour plop, interleukin-6, the Carney complex (PRKAR1A), urgent surgery, no catheter biopsy, and what to do while waiting; papillary fibroelastoma versus Lambl's excrescences and vegetations, and when to operate; lipoma, lipomatous septum, haemangioma, paraganglioma and the cystic tumour of the AV node; rhabdomyoma, tuberous sclerosis and everolimus; fibroma, Gorlin syndrome and sudden death; pericardial cysts and fetal tumours; angiosarcoma and other sarcomas; primary cardiac lymphoma; routes of metastasis, melanoma, and renal cell carcinoma extending into the right atrium; catheter thrombus and marantic endocarditis in cancer patients; the imaging pathway — TTE, TEE, cardiac MRI tissue characterisation (fat suppression, T2, perfusion, long-TI thrombus imaging, features of malignancy), CT and FDG-PET; normal structures that mimic tumours; when and how to biopsy; multidisciplinary treatment of sarcoma, lymphoma and metastatic disease; managing embolism, obstruction, tamponade, arrhythmias and SVC obstruction; post-operative complications; and long-term follow-up. Cases: a "mitral stenosis" that was a left atrial myxoma, an angiosarcoma treated as tuberculous effusion, and a papillary fibroelastoma behind recurrent strokes. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Vitamin and Micronutrient Deficiency and the Heart — How to Diagnose, Treat and Manage | 21 oct. 2026 | 00:46:11 | |
Some vitamin and micronutrient deficiencies cause life-threatening heart disease that can be cured within hours — others are linked to heart disease in observational studies, yet supplements have failed trial after trial. In this masterclass Dr. A M Thirugnanam separates the deficiencies that must never be missed from the supplements that do not protect the heart. Topics include who is at risk (elderly, alcohol, bariatric surgery, malabsorption, dialysis, vegans, pregnancy, poverty, and drugs such as loop diuretics, proton pump inhibitors and metformin); thiamine deficiency — wet beriberi, shoshin beriberi and infantile beriberi, diagnosis, "thiamine before glucose", and thiamine in heart failure on diuretics; telling beriberi from alcoholic cardiomyopathy; a practical, cost-conscious testing plan; iron deficiency in heart failure and IV iron (IRONOUT HF, CONFIRM-HF, AFFIRM-AHF, IRONMAN); B12 and folate deficiency, severe anaemia and safe transfusion; homocysteine-lowering trials (HOPE-2, NORVIT, VISP) and CSPPT; niacin (AIM-HIGH, HPS2-THRIVE); fish oil (REDUCE-IT, STRENGTH); vitamin D — VITAL, D-Health, infant low-calcium cardiomyopathy and vitamin D toxicity; antioxidant vitamins E, C and beta-carotene; scurvy; selenium and Keshan disease; copper and zinc; carnitine deficiency; coenzyme Q10 (Q-SYMBIO); folic acid in pregnancy; dialysis and post-bariatric patients; magnesium and potassium; refeeding syndrome; elderly patients; vitamin K and warfarin, and supplement interactions; and practical Indian dietary advice. Cases: shoshin beriberi mistaken for septic shock, and vitamin D toxicity worsening digoxin toxicity. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Tropical Heart Diseases — How to Diagnose, Treat and Manage Complications | 21 oct. 2026 | 00:47:51 | |
More than a third of the world lives in the tropics, where heart disease is often caused by infections, parasites, venomous bites, poverty and malnutrition — diseases of the young that are frequently missed, yet often curable. In this masterclass Dr. A M Thirugnanam gives a practical framework for diagnosis — the four Ps (place, period, profession and exposures) and the whole-body examination (eschar, conjunctival suffusion, rash, throat membrane, bite marks) — and covers: rheumatic heart disease, penicillin prophylaxis (GOAL) and warfarin in rheumatic AF (INVICTUS); cardiac involvement in dengue (and the fluid dilemma between plasma leakage and myocarditis), scrub typhus, leptospirosis, malaria, typhoid, chikungunya and other viruses; the role of cardiac MRI and biopsy; diphtheria myocarditis and heart block; tuberculous pericarditis, adenosine deaminase, GeneXpert, steroids (IMPI) and pericardiectomy; purulent and amoebic pericarditis; endomyocardial fibrosis; Chagas cardiomyopathy and benznidazole (BENEFIT); tropical infective endocarditis and culture-negative causes; scorpion envenomation and prazosin (Bawaskar); snakebite and polyvalent antivenom; wet and shoshin beriberi, anaemia and other nutritional causes; HIV and the heart; schistosomiasis, hydatid disease, sickle cell disease and peripartum cardiomyopathy; tropical heart disease in pregnancy and in returning travellers and migrants; managing complications — shock, heart block and pacing, pulmonary oedema, tamponade, constriction, thromboembolism and chronic heart failure; care in resource-limited settings; and follow-up. Cases: scrub typhus myocarditis with complete heart block mistaken for an infarction, and a child with scorpion-sting pulmonary oedema treated with prazosin. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Transcatheter Aortic Valve Replacement (TAVR) — Patient Selection, Risk Stratification, Imaging, Implantation Technique and Managing Complications | 21 oct. 2026 | 00:45:22 | |
Transcatheter aortic valve replacement has transformed the treatment of severe aortic stenosis — but every successful TAVR is won in the planning. In this masterclass Dr. A M Thirugnanam, author of "Transcatheter Aortic Valve Replacement: Tricks and Tips", walks through the whole pathway: defining severe AS and low-flow low-gradient disease (dobutamine stress echo, CT calcium score); asymptomatic severe AS and EARLY TAVR; TAVR versus SAVR and the Heart Team (PARTNER, Evolut, DEDICATE, and the 2025 ESC/EACTS age threshold of 70); what favours surgery; risk stratification with STS, EuroSCORE II, frailty and futility; ECG-gated CT for annulus sizing, calcium, coronary heights, sinuses, access and projection angles; coronary obstruction risk, valve-to-coronary distance, coronary protection and BASILICA; femoral and alternative access, intravascular lithotripsy; echocardiography; coronary CTA and PCI before TAVR (NOTION-3); balloon-expandable versus self-expanding valves (SMART); step-by-step implantation — ultrasound-guided access, pre-closure, pacing, crossing, the stiff LV wire, selective pre-dilatation, cusp-overlap view, deployment depth; assessing the result (aortic regurgitation index, PVL, post-dilatation); minimalist approach and early discharge; complications — conduction disturbances and pacemakers, vascular injury, coronary obstruction, annular rupture, LV perforation and tamponade, valve embolisation, stroke and embolic protection (PROTECTED TAVR, BHF PROTECT-TAVI); antithrombotic therapy (POPular TAVI, GALILEO) and leaflet thrombosis; durability, commissural alignment and lifetime management; bicuspid valves; valve-in-valve and ring fracture; and pure aortic regurgitation. Cases: a small-annulus, low-coronary, RBBB patient planned from the CT, and a contained annular injury managed without surgery. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Cardiac Drug Overdose and Toxicity — Recognition, Antidotes, Rescue Therapies, and Good and Poor Outcomes | 21 oct. 2026 | 00:46:33 | |
Cardiac drugs save lives every day — but in the wrong dose, the wrong patient or the wrong combination, they can stop the heart. In this masterclass Dr. A M Thirugnanam covers acute overdose and chronic toxicity of cardiac drugs: the first-hour approach (ECG, glucose, electrolytes, drug history, sustained-release preparations and 24-hour observation); activated charcoal and whole bowel irrigation with a protected airway; children and the "one tablet" danger; beta-blocker poisoning (propranolol, sotalol) — atropine, calcium, glucagon, vasopressors, pacing and high-dose insulin with glucose, and why it works; calcium channel blocker poisoning (verapamil, diltiazem, amlodipine) — high blood sugar as a severity marker, methylene blue, lipid emulsion and VA-ECMO; digoxin toxicity in the elderly — triggers, interactions, ECG clues (atrial tachycardia with block, regularised AF, bidirectional VT), interpreting levels after six hours, potassium as a severity marker, digoxin-specific antibody fragments, and care when the antidote is unavailable; yellow oleander and Cerbera poisoning; class IC antiarrhythmics and sodium bicarbonate (CAST); QT prolongation and torsades; chronic amiodarone toxicity; local anaesthetic toxicity in the cath lab; anticoagulant reversal — vitamin K and PCC for warfarin, idarucizumab for dabigatran, PCC for factor Xa inhibitors after andexanet's withdrawal from the US market (ANNEXA-I), protamine for heparin; antiplatelet bleeding and bentracimab (REVERSE-IT); bleeding after thrombolysis; clonidine, nitroprusside (cyanide), nitrates with PDE-5 inhibitors, ACE-inhibitor angioedema, statin myopathy, SGLT2-inhibitor ketoacidosis and diuretic toxicity; high potassium from drug combinations; early ECMO for refractory drug-induced shock; when a poisoned patient is safe to leave the monitor; predictors of good and poor outcomes; and compassionate care after intentional overdose. Cases: chronic digoxin toxicity after amiodarone was added (good outcome), and flecainide toxicity recognised too late (poor outcome). Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice or local poison-centre guidance. If you are struggling, please reach out to someone you trust or a crisis helpline in your country. | |||
| After a Death or Poor Outcome — Handling Medical Negligence Allegations, Chaotic Relatives and the Consequences | 21 oct. 2026 | 00:45:16 | |
A patient dies or has a poor outcome, grief turns into anger, a crowd gathers in the corridor — and afterwards come complaints, legal notices and sleepless nights. In this honest masterclass Dr. A M Thirugnanam explains how to handle medical negligence allegations, chaotic situations with relatives, and the consequences of a death or poor outcome. Topics include what negligence really is (duty, breach, causation, damage) and why a complication or death is not negligence; the Bolam principle; the Jacob Mathew judgment (2005) on gross negligence and the need for a credible medical opinion before prosecution; BNS section 106 for registered medical practitioners; consumer commissions and medical councils; prevention through honest consent, expectation setting, daily family updates and documentation; telling the family about a complication during a procedure; the first hour after a death; breaking bad news with a SPIKES-style approach; what never to say; what juniors and nurses should do; warning signs of escalation and how to calm the situation; personal safety, security, police, CCTV and FIRs when violence occurs; state protection laws and the absence of a comprehensive central law; large families, culture and interpreters; local leaders and threats; bills, and why bodies must never be held for unpaid bills (NHRC, 2021); medicolegal cases and post mortems; providing records within 72 hours; never altering records; documentation after an event; social media and the press; open disclosure and apology; legal notices, indemnity insurance, mediation and giving evidence; the "second victim" — the doctor's own distress, coping and peer support; a just culture of learning; safety for doctors in small clinics without security; and training teams with role play and violence drills. Cases: a cath lab death followed by violence and a consumer complaint that did not succeed, and a stroke after a valve procedure handled with honesty and presence. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is general information, not legal advice; laws differ between countries and states — consult a qualified medicolegal adviser about your own situation. | |||
| Refractory Decompensated Heart Failure — Diuretic Resistance, Cardiorenal Syndrome, Low Output and What to Do the Best | 21 oct. 2026 | 00:45:23 | |
The swollen, breathless patient who is not responding to diuretics, whose kidneys are worsening and whose blood pressure is too low for the medicines we want to give — refractory decompensated heart failure carries a very high risk of death. In this masterclass Dr. A M Thirugnanam gives a structured approach: the four questions to ask first (is the diagnosis right, what is the haemodynamic profile, what was the trigger, is there a reversible cause); warm/cold and wet/dry profiles; precipitants and reversible causes (valve disease, ischaemia, tachycardia-mediated cardiomyopathy, constriction, amyloid); immediate relief with non-invasive ventilation and nitrates; adequate IV loop diuretic dosing (DOSE); early urine sodium and urine output to guide treatment (PUSH-AHF); sequential nephron blockade with acetazolamide (ADVOR), thiazides (CLOVER) and SGLT2 inhibitors (EMPULSE); albumin and diuretic response; daily monitoring, natriuretic peptides and lung ultrasound; the cardiorenal syndrome — why congestion, not low flow, usually drives the rising creatinine; ultrafiltration (CARRESS-HF); low sodium and tolvaptan; salt and fluid advice (SODIUM-HF); right-sided failure; inotropes for the cold patient (DOREMI) and when to use a pulmonary artery catheter (ESCAPE); continuing beta-blockers and rapid GDMT up-titration (STRONG-HF); HFpEF (EMPEROR-Preserved, DELIVER, STEP-HFpEF); IV iron (AFFIRM-AHF, IRONMAN), AF ablation (CASTLE-AF, CASTLE-HTx), CRT, TEER (COAPT) and vericiguat (VICTORIA); "I NEED HELP" and advanced therapies — temporary MCS, HeartMate 3 LVAD (MOMENTUM 3) and transplantation; palliative care (PAL-HF); frail and kidney patients; eight common mistakes; and safe discharge with early follow-up. Cases: a "refractory" patient who was really undertreated, and a cold, wet patient bridged with Impella to LVAD and transplant. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Primary Angioplasty in Acute STEMI — Stabilise or Go Straight to the Table? Why Patients Die on the Table and How to Prevent It | 21 oct. 2026 | 00:46:31 | |
Primary angioplasty has transformed survival after STEMI — yet the sickest patients still die in the first hours, often on the cath lab table. In this masterclass Dr. A M Thirugnanam answers the hard questions. Topics include why primary PCI is preferred, the 90- and 120-minute targets and the pharmaco-invasive strategy (STREAM); whether to stabilise first or go straight to the lab — "stabilise while you move": rhythm, airway, blood pressure, potassium, defibrillator pads and a bedside echo in the first 15 minutes; pre-lab drugs (aspirin, ticagrelor/prasugrel, heparin; morphine delaying absorption; no routine oxygen — DETO2X; no IV beta-blockers in heart failure — COMMIT); nitrates in RV infarction; consent and talking to the family; when not to go straight to the lab (aortic dissection, major bleeding, late stable presenters — OAT, futile arrest); post-arrest STEMI (COACT, TOMAHAWK); the causes of death on the table — shock, reperfusion VF, Bezold-Jarisch bradycardia, no-reflow, mechanical complications, procedural complications, bleeding, respiratory failure and missed diagnoses; high-risk groups; lab preparation; radial versus femoral access (MATRIX, RIVAL); technique and imaging; selective thrombus aspiration (TASTE, TOTAL, DANAMI-3 DEFER); heparin, ACT targets, bivalirudin (BRIGHT-4) and bail-out GP IIb/IIIa; RV infarction in the lab; preventing and treating no-reflow; perforation, dissection and acute stent thrombosis; left main occlusion; cardiogenic shock — SHOCK, CULPRIT-SHOCK, IABP-SHOCK II, ECLS-SHOCK and DanGer Shock; complete revascularisation (COMPLETE, FIRE); the first 48 hours in the CCU and mechanical complications; eight common mistakes; and building a STEMI system. Cases: anterior STEMI with shock and VF treated with parallel stabilisation and Impella; nitrate-induced collapse in RV infarction; and type A dissection masquerading as inferior STEMI. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Diagnosing the Missed and Never-Seen-Before Case in Cardiology — Rare, Hidden and Challenging Diagnoses | 21 oct. 2026 | 00:45:11 | |
Every doctor eventually meets the patient who does not fit — the case labelled anxiety, viral or "just age", or the condition you have never seen before. In this masterclass Dr. A M Thirugnanam shares a step-by-step method for finding the hidden diagnosis. Topics include why diagnoses are missed (anchoring, diagnosis momentum, premature closure, attribution to age or anxiety); the four kinds of difficult case; starting again from zero with your own history, timeline, three-generation family history, travel, occupation and drug history; whole-body examination (skin, eyes, joints, all four pulses, both-arm blood pressure); problem representation, the "pivot" finding and the "orphan" finding; Occam's razor versus Hickam's dictum; a systematic anatomical and causal framework; common diseases in unusual dress and the "worst case" question; quiet ECG and lab clues (epsilon wave, fever-unmasked Brugada, low voltage with thick walls, eosinophilia, raised calcium, CK in checkpoint-inhibitor myocarditis); MINOCA and why a clean angiogram is not the end; cardiac MRI tissue patterns, FDG-PET, CT, bone scintigraphy, endomyocardial and extracardiac biopsy, and genetic testing; excluding TB before steroids; why the expert reviews the raw images and tracings himself (apical HCM hidden behind a "normal" echo); caring for the frustrated patient who has seen many doctors; managing the strange case at night in a small hospital; second opinions, literature search and safe use of AI; what to do when no diagnosis is found; eight common mistakes; and habits that build diagnostic skill. Real cases: an anomalous coronary artery behind exertional syncope, Fabry disease mistaken for HCM, transthyretin amyloidosis behind "HFpEF" (ATTR-ACT), atrial myxoma mimicking mitral stenosis, Takayasu arteritis labelled as anxiety, wet beriberi mimicking septic shock, scrub typhus myocarditis, and "idiopathic" dilated cardiomyopathy that proved to be treatable cardiac sarcoidosis. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| What Makes an Expert Cardiologist — How They Think, Behave and Pursue Perfection in Diagnosis and Procedures | 21 oct. 2026 | 00:45:30 | |
Expertise is built, not born. In this masterclass we explore what separates an expert cardiologist from an experienced one — and how they pursue perfection in everything within their control. Topics include an honest look at "100% success" (aiming for 100% effort, preparation and honesty rather than claiming perfect outcomes); a deep foundation in physiology and evidence, including knowing who trials such as ISCHEMIA excluded; combining fast pattern recognition with slow analytical reasoning; the cognitive traps — anchoring, premature closure, confirmation and availability bias, diagnosis momentum — and the questions "what else could this be?" and "what is the worst it could be?"; systematic ECG reading; history and examination as the most powerful diagnostic tools; purposeful use of investigations and pretest probability; expert procedural practice — patient selection, preparation, mental rehearsal, bail-out planning, intravascular imaging and physiology, knowing when to stop, and the expert's ten-point pre-procedure checklist; calm, prepared leadership during complications; communicating with patients and breaking bad news; teamwork, safety culture and the Heart Team (SYNTAX, EXCEL, FREEDOM); handling uncertainty and second opinions; daily organisation; critical use of AI; deliberate practice, outcome audit and M&M meetings; humility, curiosity, discipline, integrity and compassion; burnout prevention; excellence in long-term secondary prevention; teaching and mentoring; and ten daily habits for young cardiologists — illustrated with a "NSTEMI" that an expert consultant recognised as type A aortic dissection. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| The Best Books from cardiologybooks.com for Cardiologists at Every Level — and How to Use Them in Daily Practice | 21 oct. 2026 | 00:45:06 | |
Which book should you read first — and how do you actually use it on the ward, in the cath lab, in the ICU and in the exam hall? In this special episode, the author takes us on a guided, level-by-level tour of the cardiologybooks.com library. We cover the philosophy behind the books (practical, reasoning-based, evidence-based and instantly downloadable) and why they use numbered notes, algorithms and cases; how they complement large textbooks and guidelines; foundations for students and juniors (ECG Quick Notes, Cardiology Pathophysiology Quick Notes 1500, Quick Cardiology Notes); books for non-cardiologists (Cardiology Quick Notes for Non-Cardiologist, Cardiology for Every Specialty, General Medicine Quick Notes 2000); board preparation (Complete Cardiology MCQ Guide, Think Like an Examiner, Pass the Cardiology Boards in 60 Days, The Differential Drill); case-based learning (Differential Diagnosis in Cardiology: 1800 Clinical Cases, Cardiology Cases That Teach, The World's Greatest Cardiology Cases); clinical judgement for consultants (The Cardiologist's Black Book, An Art of Making Right Diagnosis in Cardiology, The Expert Cardiologist's Diagnostic Mind, The Chest Pain Algorithm, The ECG Masterclass, echo quick notes); interventional and structural (Interventional Cardiology Essentials, Calcium, Clots & Consequences, Coronary Calcium: From Score to Stent, TAVR Tricks and Tips, TEER of the Mitral and Tricuspid Valves, Precision Anticoagulation); ICU and emergencies (Cardiogenic Shock: The First Six Hours, Mastering Cardiac Emergencies, Critical Care Quick Notes, the Critical Care and Emergency Drugs Monograph Handbook, Arrhythmia Management, Mastering Antibiotic Therapy, DIC); subspecialty and future-focused titles (ACHD, Cardio-Oncology, Autoimmune Disease, Rheumatic Heart Disease, Advanced Diabetic Management, AI in Cardiology, Circadian Cardiology, Climate Change, Exercise); career and research (Beyond the Stethoscope, Every Doctor Can Publish); the Cardiology Nursing Guide; patient-education books; teaching use, resource-limited settings, choosing a bundle, a first-year fellowship reading plan, returning to practice, patient safety, practical tips for getting the most from e-books, and the daily reading habits that turn every working day into structured learning. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Perfect Ventilator Settings in Heart Failure and Cardiac Critical Care — Management and Complications | 21 oct. 2026 | 00:44:37 | |
The ventilator is not just a breathing machine — it is a powerful haemodynamic tool. In this cardiac critical care masterclass we cover heart–lung interactions (positive pressure lowers preload and LV afterload but can raise RV afterload); noninvasive ventilation in acute cardiogenic pulmonary oedema — CPAP and BiPAP settings, the 3CPO trial, contraindications and high-flow nasal oxygen; why intubation is so dangerous in cardiac patients and how to make it safer (pre-induction vasopressors, preoxygenation, reduced-dose ketamine or etomidate, video laryngoscopy); initial ventilator settings — 6–8 mL/kg predicted body weight, plateau <30, driving pressure <15, titrated FiO2; avoiding excess oxygen (AVOID, DETO2X, BOX); PEEP titration for LV versus RV failure; volume versus pressure control and pressure support; monitoring with arterial lines, end-tidal CO2, echo, lung ultrasound and PA catheters; ventilating the failing right ventricle — normal CO2, low PEEP and lung volumes, inhaled nitric oxide or epoprostenol; intubation in massive PE; ventilation in cardiogenic shock; lung-rest settings on VA-ECMO, LV distension and North–South (Harlequin) syndrome; post-cardiac-arrest targets (BOX, TAME); tamponade, aortic stenosis, obstructive HCM and Fontan circulation; auto-PEEP; weaning-induced pulmonary oedema and extubation to NIV; fast-track extubation after cardiac surgery; complications and the DOPES approach to sudden deterioration — illustrated with an anterior STEMI patient progressing from CPAP to intubation, Impella support and successful weaning. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Selecting the Right Antibiotic and Preventing Antibiotic Resistance — Complications and Effective Management | 21 oct. 2026 | 00:46:01 | |
Every antibiotic prescription has two sides: it can save a life within hours, or it can harm the patient and breed resistance. In this masterclass we cover a practical, systematic approach to antibiotic selection: deciding whether an antibiotic is needed at all; the five questions — site, likely organisms, the patient, severity and the local antibiogram; tissue penetration and why source control (abscess drainage, device extraction, early surgery in endocarditis) is essential; timing in sepsis and septic shock (Surviving Sepsis Campaign) and "start smart, then focus"; risk factors for MRSA, ESBL and Pseudomonas; narrowing therapy once cultures return (flucloxacillin or cefazolin over vancomycin for MSSA); IV-to-oral switch, with the POET and OVIVA trials; PK/PD dosing — time- versus concentration-dependent killing, extended infusions, AUC-guided vancomycin, loading doses, renal and hepatic adjustment and augmented renal clearance; short-course evidence (STOP-IT and others) and procalcitonin; penicillin allergy de-labelling (PALACE); when combination therapy is justified; practical empirical choices for pneumonia, UTI, cellulitis, line infection and endocarditis; pregnancy, the elderly and children; how resistance develops and the organisms of concern; stewardship actions for every doctor; antibiotic misuse in cardiology — prophylaxis, endocarditis prophylaxis and WRAP-IT; complications — C. difficile, nephrotoxicity, ototoxicity, QT prolongation, fluoroquinolone aortic risk, rifampicin and macrolide interactions with warfarin, DOACs, ticagrelor and statins; anaphylaxis and severe cutaneous reactions — illustrated with MSSA prosthetic valve endocarditis in a patient with a false penicillin allergy label. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Myocardial Bridging with Recurrent Angina — Complications and Effective Management | 21 oct. 2026 | 00:45:02 | |
Often dismissed as a harmless variant, a myocardial bridge can cause recurrent angina, MINOCA, ventricular arrhythmias and even sudden death. In this masterclass we cover what a bridge is and how common it is on angiography, CT and autopsy; why it causes ischaemia — delayed diastolic relaxation worsened by tachycardia and contractility, endothelial dysfunction and vasospasm, proximal atherosclerosis, septal branch steal and microvascular dysfunction; clinical presentations and red flags, including worsening with nitrates; special groups — HCM, athletes and transplant recipients; counselling; the differential diagnosis of angina with "normal" coronaries; angiography (milking effect, intracoronary nitroglycerin), IVUS half-moon sign and OCT; why conventional FFR underestimates bridges and the role of dobutamine diastolic FFR (≤0.76), resting diastolic indices and acetylcholine testing; CT depth and length, stress echo septal buckling, perfusion imaging and cardiac MRI; medical therapy — beta blockers (heart-rate targets, choice and dosing), non-dihydropyridine calcium channel blockers, ivabradine, ranolazine, secondary prevention and trigger avoidance; when to intervene; why stenting the tunnelled segment is risky (fracture, restenosis, perforation) and how to treat a proximal plaque; surgical unroofing (supra-arterial myotomy), its complications, and CABG with the competitive-flow pitfall; complications of the bridge, ACS management, follow-up, new developments and common mistakes — illustrated with a young runner with a "normal" angiogram whose dobutamine diastolic FFR and acetylcholine test revealed the cause. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Inoperable and Non-Stentable Small-Vessel Disease — Drug-Coated Balloons, Lesion Preparation and Debulking | 21 oct. 2026 | 00:45:42 | |
Not every lesion needs a stent, and not every patient can have surgery. In this cath-lab masterclass we cover the "leave nothing behind" strategy for inoperable patients and non-stentable lesions: who these patients are — no-option surgical candidates, small vessels, diffuse disease, in-stent restenosis, high bleeding risk and side branches; why small vessels do badly with stents; the evidence for drug-coated balloons — BASKET-SMALL 2, PICCOLETO II, RESTORE SVD, BELLO, and the limits shown by REC-CAGEFREE I; how DCBs work — paclitaxel versus sirolimus, excipients, vasomotion and late lumen enlargement; the paclitaxel safety question; lesion preparation to International DCB Consensus criteria (residual stenosis ≤30%, no flow-limiting dissection, TIMI 3) and pressure-wire support; non-compliant, scoring, cutting and super-high-pressure balloons; debulking in small vessels with rotational and orbital atherectomy, intravascular lithotripsy and excimer laser; calcium as a barrier to drug delivery; IVUS/OCT sizing; step-by-step DCB technique (0.8–1.0 sizing, margins to avoid geographic miss, rapid delivery, 30–60-second inflation, single use); DCB-only and hybrid DES–DCB strategies for diffuse disease and CTO; in-stent restenosis (AGENT IDE); complications — dissection classification and bail-out stenting, recoil, perforation in small vessels, slow flow after atherectomy; shortened DAPT (DEBUT) and follow-up; common mistakes — illustrated with a frail diabetic woman with a calcified small LAD treated with Rota, scoring balloon and DCB with one month of DAPT. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Calcified Left Main Bifurcation PCI — Selection of Materials, Complications and Management | 21 oct. 2026 | 00:46:08 | |
The calcified left main bifurcation combines the three hardest challenges in PCI — the left main, a bifurcation and calcium. In this cath-lab masterclass we cover the Heart Team decision (SYNTAX score, EXCEL, NOBLE and the SYNTAX left main subgroup); pre-procedure planning — angiographic analysis, LV function, access, contrast and kidney protection, and planned mechanical support; why calcium causes stent under-expansion and why lesion preparation comes before stenting; IVUS and OCT assessment — calcium arc, thickness and length, the OCT calcium score, left main MLA thresholds, and evidence for imaging guidance (RENOVATE-COMPLEX-PCI, OCTOBER); the calcium toolbox — non-compliant, scoring, cutting and super-high-pressure balloons, rotational and orbital atherectomy, intravascular lithotripsy (Disrupt CAD III), "Rota-tripsy" and excimer laser; safe rotational atherectomy technique and lithotripsy technique at the left main; one-stent versus two-stent strategy (DEFINITION II, DKCRUSH-V, EBC MAIN); step-by-step provisional stenting with POT, rewiring and kissing, and double kissing crush, culotte and TAP; material selection — guides, guide extensions, wires, balloons and stent expansion limits; stent sizing with Finet's law and IVUS minimal stent area targets; complications and bail-out — circumflex occlusion, slow flow after atherectomy, perforation and covered stents, burr entrapment (Kokeshi phenomenon), wire entrapment and stent loss, stent under-expansion, and haemodynamic collapse; antithrombotic therapy (DAPT, PRECISE-DAPT, ARC-HBR, AUGUSTUS) and follow-up — illustrated with a high-surgical-risk diabetic patient treated with Impella-supported rotational atherectomy, lithotripsy and DK crush. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Sudden Cardiac Death with Normal Cardiac Tests — What Has Been Missed | 21 oct. 2026 | 00:43:42 | |
A normal ECG, a normal echo, a normal treadmill test and even a normal angiogram — yet the heart stopped. In this masterclass we explore sudden cardiac death with normal cardiac tests: why routine tests miss the cause, and how to find it. Topics include sudden arrhythmic death syndrome (SADS) and idiopathic VF; why intermittent and concealed diseases escape detection; the channelopathies — long QT (borderline QT, failure to shorten in exercise recovery, T wave morphology), Brugada (high right precordial leads, fever, ajmaline or flecainide challenge), CPVT, short QT and early repolarisation syndrome; subtle ECG clues — intermittent pre-excitation, epsilon waves, right precordial T inversion, low voltage and short-coupled ectopy; how to measure the QT manually (tangent method, Bazett versus Fridericia); concealed cardiomyopathies — arrhythmogenic, genetic DCM (lamin A/C, filamin C, desmoplakin, RBM20), mild or apical HCM, myocarditis and sarcoidosis — and the role of cardiac MRI and FDG-PET; coronary causes hidden behind a normal angiogram — anomalous origin, bridging, spasm, SCAD and non-obstructive plaque rupture; drugs, electrolytes, endocrine causes, sleep apnoea and pulmonary embolism; epilepsy misdiagnosis and SUDEP; prolonged monitoring and implantable loop recorders; athlete screening; a step-by-step work-up of cardiac arrest survivors; genetic testing, molecular autopsy and family cascade screening; treatment by diagnosis — beta blockers, quinidine, flecainide, ablation, surgery and ICDs; complications of ICDs, drugs and ablation, electrical storm management, asymptomatic ECG patterns, and system improvements for emergency departments and pathologists — illustrated with a young swimmer whose "epilepsy" was long QT syndrome type 1. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Microvascular Angina and Sudden Cardiac Death — Causes, Complications and Management | 21 oct. 2026 | 00:43:54 | |
A normal angiogram does not mean a normal heart — and many sudden deaths strike people who never had a warning. In this masterclass we cover microvascular angina and the causes, prevention and management of sudden cardiac death. Topics include INOCA and ANOCA; impaired vasodilation versus microvascular and epicardial spasm; risk factors and why women are more affected; invasive coronary function testing — FFR, coronary flow reserve, index of microcirculatory resistance and acetylcholine provocation — and the CorMicA trial; non-invasive PET, perfusion MRI and Doppler; mechanism-based treatment — beta blockers, calcium channel blockers, nitrates, ranolazine, ivabradine, nicorandil, trimetazidine, low-dose tricyclics, rehabilitation and the coronary sinus reducer; prognosis (WISE) and the link with HFpEF; the definition and burden of sudden cardiac death; causes by age — coronary disease and cardiomyopathy in older adults, inherited cardiomyopathies and channelopathies (long QT, Brugada, CPVT, WPW) in the young, plus valve disease, dissection, PE, drugs, electrolytes, commotio cordis, vasospasm and SCAD; red flags and the ECG patterns every doctor must recognise; risk stratification with EF, cardiac MRI and the HCM Risk-SCD score; prevention — heart failure therapy, avoiding triggers, ICDs (MADIT-II, SCD-HeFT), ICD timing after MI (DINAMIT, IRIS), wearable (VEST) and subcutaneous defibrillators, ablation and family screening; ICD complications and programming (MADIT-RIT); athlete screening; drug-induced QT prolongation (CredibleMeds); the chain of survival, bystander CPR and public-access defibrillators; and investigating survivors and families — illustrated with a teacher with "normal" angiograms whose VF arrest was caused by coronary spasm with microvascular dysfunction. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Acute MI During Cancer Treatment — Complications and Effective Management | 21 oct. 2026 | 00:45:32 | |
An acute myocardial infarction in the middle of chemotherapy — with low platelets, a tumour that could bleed, surgery planned next week, and a cancer drug that may have caused the event. In this masterclass we cover how to diagnose and treat MI during cancer treatment while keeping cancer therapy on track. Topics include why cancer and its treatment raise MI risk (shared risk factors, the pro-thrombotic state, radiotherapy, demand ischaemia); culprit drugs — 5-FU and capecitabine, cisplatin, VEGF inhibitors, ponatinib and nilotinib, immune checkpoint inhibitors, androgen deprivation (HERO), thalidomide and lenalidomide; mimics — vasospasm, checkpoint inhibitor myocarditis, PE, Takotsubo, tamponade, type 2 MI; why a cancer diagnosis should not prevent primary PCI, and why thrombolysis is often contraindicated; SCAI platelet thresholds for angiography, aspirin, clopidogrel and avoiding prasugrel/ticagrelor, with reduced heparin; radial access, intravascular imaging and radiation-related coronary disease; short DAPT with modern stents (LEADERS FREE, ONYX ONE, MASTER DAPT) and drug-coated balloons; NSTEMI strategy; blood cancers — leukaemia, APL, leucostasis, myeloproliferative neoplasms, myeloma and amyloid; brain metastases and bleeding tumours; fluoropyrimidine vasospasm, rechallenge and switching to raltitrexed; checkpoint myocarditis versus MI; cancer-associated VTE with minimal triple therapy (AUGUSTUS, PIONEER AF-PCI, Caravaggio); cancer surgery after a stent and cangrelor bridging; cardiogenic shock and goals of care; CAR-T cytokine release syndrome; anaemia and transfusion (MINT); statins (STOP-CA) and drug interactions; baseline risk assessment (HFA-ICOS), survivorship and family communication — illustrated with an inferior STEMI on capecitabine treated with PCI and a switch to raltitrexed. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Acute MI During Labour and Delivery — Complications and Effective Management | 21 oct. 2026 | 00:43:39 | |
A young mother in labour develops crushing chest pain, a fall in blood pressure, or collapses — an acute myocardial infarction in the labour ward, with two lives at stake. In this masterclass we cover how the cardiologist, obstetrician, anaesthetist and neonatologist recognise and manage it together. Topics include how common pregnancy-associated MI is and who is at risk; the enormous haemodynamic stress of labour and the postpartum surge; why spontaneous coronary artery dissection (SCAD) — not atherosclerosis — is the commonest cause, plus thrombosis, vasospasm and MINOCA; recognising MI in labour with the ECG, troponin and echo; the mimics — pulmonary embolism, aortic dissection, peripartum cardiomyopathy, amniotic fluid embolism, Takotsubo and Kounis syndrome; first steps — the mother comes first, left lateral tilt, aspirin; primary PCI versus thrombolysis, fetal radiation, and deciding whether to deliver first or go to the cath lab first; conservative management of SCAD versus intervention; antiplatelets, clopidogrel and neuraxial anaesthesia, unfractionated heparin; beta blockers, nitrates, ACE inhibitors after delivery, statins; dangerous obstetric drugs — ergometrine, bromocriptine, rapid oxytocin, carboprost — and safer haemorrhage control with tranexamic acid; mode of delivery and epidural planning; pre-eclampsia and HELLP; maternal and fetal complications; maternal cardiac arrest with left uterine displacement and perimortem caesarean section within five minutes; cardiogenic shock and mechanical support; labour ward preparedness and drills; the first six weeks postpartum; future pregnancy after SCAD, fibromuscular dysplasia screening, breastfeeding and contraception — illustrated with an anterior STEMI from LAD dissection at 39 weeks, assisted delivery and conservative SCAD management. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Acute MI During Non-Cardiac Surgery — Complications and Effective Management | 21 oct. 2026 | 00:44:15 | |
The monitor shows ST elevation in the middle of a laparotomy, the blood pressure falls, and every heart-attack treatment carries a risk of surgical bleeding. In this masterclass we cover acute myocardial infarction during and after non-cardiac surgery, and how the surgeon, anaesthetist and cardiologist handle it effectively as one team. Topics include how common perioperative cardiac events are and why most are silent (VISION); type 1 plaque rupture versus type 2 supply–demand infarction; the first minutes in theatre — confirming ST changes with a 12-lead ECG and TEE, and correcting low blood pressure, bleeding, tachycardia and low oxygen; mimics in theatre — massive PE, anaphylaxis and Kounis syndrome, Takotsubo, vasospasm and bone cement implantation syndrome; damage-control surgery and why thrombolysis is contraindicated after major surgery; primary PCI with aspirin, clopidogrel, radial access, minimal unfractionated heparin, no GP IIb/IIIa, and short DAPT with modern stents (LEADERS FREE, ONYX ONE, MASTER DAPT); NSTEMI and type 2 events; myocardial injury after non-cardiac surgery (MINS), troponin surveillance and the MANAGE trial; cardiogenic shock after surgery and the limits of mechanical support; how vascular, hip fracture, neuro/spinal, cancer and liver surgery change the approach; cardiac arrest in theatre and perioperative causes; postoperative AF; preoperative assessment (2022 ESC guideline, RCRI) and why not to revascularise first (CARP); beta blockers (POISE), aspirin (POISE-2), blood pressure and tranexamic acid (POISE-3); recent stents, bridging with cangrelor; team roles and follow-up — illustrated with an inferior STEMI during emergency laparotomy managed with damage-control surgery and primary PCI. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Acute MI in Patients on Dialysis — Complications and Effective Management | 21 oct. 2026 | 00:46:16 | |
Patients on dialysis carry an extraordinary cardiovascular risk — yet they were left out of almost every major trial. In this masterclass we cover how to diagnose and treat acute myocardial infarction in patients with kidney failure on dialysis, and how to manage the many complications. Topics include why coronary disease is so aggressive in kidney failure (medial calcification, mineral bone disorder, inflammation, anaemia, LV thickening); atypical presentations — breathlessness, falls in blood pressure during dialysis, arrhythmias; interpreting the ECG with LV strain, LBBB and potassium changes; chronically raised troponin and the importance of the rise and fall; primary PCI without delay for contrast, protecting residual renal function; thrombolysis with unfractionated heparin when PCI is unavailable; protecting the fistula arm and future access, ultrasound-guided femoral access; severe calcium — IVUS/OCT, cutting and scoring balloons, rotational and orbital atherectomy, intravascular lithotripsy; antiplatelets in dialysis (PLATO), dialysis as a high-bleeding-risk criterion and short DAPT (MASTER DAPT); unfractionated heparin versus enoxaparin, fondaparinux, bivalirudin and GP IIb/IIIa dosing; NSTEMI strategy and CABG versus PCI (ISCHEMIA-CKD); timing dialysis around emergency PCI; gentle dialysis after MI, potassium shifts and sudden death around sessions (ICD2); bleeding, PPIs and desmopressin; beta blockers, statins (4D, AURORA, SHARP), RAAS blockers, SGLT2 inhibitors (DAPA-CKD, EMPA-KIDNEY), metformin and insulin; anaemia and transfusion (TREAT); AF anticoagulation, DAT (AUGUSTUS, PIONEER AF-PCI) and LAA occlusion; cardiogenic shock with CRRT and mechanical support (CULPRIT-SHOCK); peritoneal dialysis patients; frailty and goals of care; and shared cardiology–nephrology follow-up and transplant review — illustrated with a Monday-morning anterior STEMI with a raised potassium treated with lithotripsy-assisted PCI. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Haemorrhagic Stroke, Accelerated Hypertension and Acute MI — Effective Management | 21 oct. 2026 | 00:43:46 | |
A bleeding brain, a blocked coronary artery, and a blood pressure through the roof — every treatment that helps the heart seems to harm the brain. In this masterclass we cover how to handle acute intracerebral haemorrhage with accelerated hypertension together with an acute myocardial infarction. Topics include why the two strike together; the first and most important question — true coronary occlusion or neurogenic stunned myocardium (brain–heart syndrome); subarachnoid haemorrhage mimicking anterior STEMI; how this differs from ischaemic stroke with MI and the danger of aortic dissection; why thrombolysis is absolutely contraindicated; when and how to perform primary PCI — team decision, radial access, minimal heparin, no GP IIb/IIIa or cangrelor, balloon-only and staged stenting; antiplatelet timing and short DAPT with high-bleeding-risk stents (LEADERS FREE, ONYX ONE, MASTER DAPT), avoiding ticagrelor and prasugrel; anticoagulation and VTE prevention; aligning blood pressure targets (INTERACT2, INTERACT3) with ischaemia — nicardipine, clevidipine, labetalol, esmolol, and caution with nitroglycerine; cardiogenic shock, cerebral perfusion pressure and the limits of mechanical support; the reverse scenario — intracranial haemorrhage after thrombolysis or PCI, with immediate reversal (cryoprecipitate, tranexamic acid, protamine, PATCH); restarting antiplatelets with a fresh stent (RESTART); arrhythmias, QT, LV thrombus and other complications; NSTEMI strategy (ISCHEMIA) and delayed CABG (SYNTAX, FREEDOM); AF on anticoagulation — reversal, avoiding triple therapy, DAT (AUGUSTUS, PIONEER AF-PCI) and LAA occlusion; a first-hour checklist; family communication; and long-term prevention (PROGRESS, SPRINT) — illustrated with a thalamic haemorrhage and inferior STEMI treated with balloon-only PCI and staged stenting. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Acute Haemorrhagic Stroke with Accelerated Hypertension — Complications and Management | 21 oct. 2026 | 00:44:22 | |
A bleed in the brain, a blood pressure of 240/140, and every minute counting. In this masterclass we cover acute intracerebral haemorrhage with accelerated hypertension — and why it is very much the cardiologist's problem. Topics include why hypertension causes deep (putaminal, thalamic, pontine, cerebellar) haemorrhages, and when to suspect amyloid angiopathy, malformations or drugs; hypertensive emergency and malignant hypertension with multi-organ damage; the first minutes — airway, GCS, glucose and non-contrast CT before any antithrombotic; haematoma volume, intraventricular blood, CT angiography and the spot sign; how fast and how far to lower blood pressure (INTERACT2, ATACH-2) and the INTERACT3 care bundle; handling pressures above 220; drug choice — nicardipine, clevidipine, labetalol, esmolol, urapidil — and why to avoid sublingual nifedipine and nitroprusside; immediate reversal of warfarin (4F-PCC, vitamin K), dabigatran (idarucizumab) and factor Xa inhibitors (andexanet, ANNEXA-I, or PCC); why platelet transfusion harms antiplatelet-related bleeds (PATCH); tranexamic acid (TICH-2) and factor VIIa; intracranial pressure, external ventricular drainage, and surgery (STICH, ENRICH, cerebellar haematomas); the brain–heart syndrome and neurogenic stunned myocardium versus MI; arrhythmias and the Cushing response; kidney, eye and thrombotic microangiopathy damage and secondary causes; supportive care, VTE prevention (CLOTS) and seizures; pregnancy-related and stimulant-related haemorrhage; long-term BP targets (PROGRESS); and restarting antiplatelets (RESTART) and anticoagulation for AF or mechanical valves (SoSTART, APACHE-AF, LAA occlusion) — illustrated with an AF patient on apixaban with a putaminal bleed and malignant hypertension who recovered and safely restarted anticoagulation. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Acute MI with Cardiogenic Shock When No Cath Lab Is Available — Complications and Management | 21 oct. 2026 | 00:45:53 | |
Most heart attack patients first reach a hospital without a cath lab. In this masterclass for doctors in district, rural and secondary hospitals, we cover how to manage acute myocardial infarction with cardiogenic shock when primary angioplasty is not in the building. Topics include the scale and mortality of infarct-related shock and the lesson of the SHOCK trial; the first ten minutes — 12-lead ECG, defibrillator pads, aspirin, oxygen only when needed (DETO2X); identifying LV failure, right ventricular infarction (V4R) and mechanical complications, with bedside echo; STEMI equivalents (posterior MI, new LBBB, aVR elevation), shock without ST elevation and mimics such as massive PE; the 120-minute rule — when to transfer and when to thrombolyse, and the pharmaco-invasive strategy (STREAM); tenecteplase dosing including half dose at 75 and over, enoxaparin and clopidogrel, and why streptokinase is a problem in shock; contraindications and excluding aortic dissection; fibrinolysis after cardiac arrest and in the very elderly; recognising successful versus failed reperfusion, rescue PCI and routine angiography within 2–24 hours; norepinephrine first, dobutamine, and why dopamine is avoided (SOAP II); safe peripheral vasopressors and extravasation; pulmonary oedema with low blood pressure and non-invasive ventilation; right ventricular infarction — fluids, no nitrates, pacing; arrhythmias, heart block and when not to give beta blockers; recognising mechanical complications; the IABP question (IABP-SHOCK II); safe inter-hospital transfer; complications of thrombolysis including intracranial haemorrhage; care when transfer is impossible; the first 24 hours after lysis; and building hub-and-spoke STEMI networks and door-to-needle audits — illustrated with a farmer with anterior STEMI and shock, thrombolysed at a district hospital and stented the same day. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Refractory Ventricular Arrhythmias in Dilated Cardiomyopathy with Sepsis — Complications and Management | 21 oct. 2026 | 00:44:30 | |
A patient with dilated cardiomyopathy develops sepsis — then shock after shock from ventricular tachycardia and fibrillation that won't stop. In this masterclass we cover how to tame an electrical storm while treating the infection and supporting a failing pump. Topics include the definition and prognosis of electrical storm; why a dilated, scarred ventricle is electrically unstable (mid-wall and epicardial scar, lamin A/C, filamin C, desmoplakin, sarcoid, myocarditis, Chagas); how sepsis triggers storm — catecholamines, fever, electrolytes, acidosis, low oxygen, QT-prolonging drugs, septic cardiomyopathy and line tips; immediate cardioversion and defibrillation; monomorphic versus polymorphic VT; torsades — magnesium, potassium, stopping culprit drugs and raising the heart rate; the trigger checklist and immediate device interrogation for inappropriate shocks; amiodarone, lignocaine and mexiletine; beta blockade in storm (MANIA) and short-acting esmolol or landiolol in shock; reducing pro-arrhythmic inotropes, vasopressin, levosimendan and mechanical support to wean catecholamines; fluid strategy in a septic patient with an EF of 20%; sedation and intubation; overdrive pacing, ICD reprogramming, stellate ganglion block and sympathetic denervation; catheter ablation (VANISH, PARTITA, VANISH2), epicardial access, and haemodynamic support during ablation (PAINESD); QT-safe antibiotic choices; CIED infection, lead extraction and bridging; complications from shocks, drugs and procedures; caring for patients after multiple shocks and programming to avoid them (MADIT-RIT); secondary-prevention ICD, CRT and full heart failure therapy; LVAD, transplant and end-of-life device deactivation — illustrated with a DCM patient with pneumococcal septic shock and a VT storm, rescued and later ablated with Impella support. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Refractory Atrial Arrhythmias in Normal and Failing Left Ventricle — Complications and Management | 21 oct. 2026 | 00:45:04 | |
Atrial fibrillation, flutter or atrial tachycardia that won't settle — in a patient with a normal left ventricle, and in one whose ventricle has already failed. In this masterclass we cover how the state of the LV changes almost every decision. Topics include whether an arrhythmia is truly refractory (wrong diagnosis, drug or dose, and untreated triggers — thyroid, alcohol, sleep apnoea, obesity, electrolytes); failure of rate control versus failure of rhythm control; recognising flutter and focal atrial tachycardia; risk factor management (LEGACY) and the updated CHA2DS2-VA score; rate and rhythm drugs in the normal heart — beta blockers, diltiazem, verapamil, flecainide, propafenone ("pill in the pocket"), sotalol, dronedarone; first-line ablation (EARLY-AF, STOP AF First, Cryo-FIRST) and pulsed field ablation (ADVENT); ablation complications including tamponade, phrenic palsy and atrio-oesophageal fistula; the AF–heart failure vicious circle and reversible tachycardia-induced cardiomyopathy; safe rate control in HFrEF — avoiding diltiazem and verapamil, beta blockers, digoxin (RATE-AF), amiodarone, lenient targets (RACE II); rhythm control in HFrEF — CAST, ANDROMEDA, and catheter ablation (CASTLE-AF, CASTLE-HTx); AF in HFpEF, SGLT2 inhibitors (EMPEROR-Preserved, DELIVER) and early rhythm control (EAST-AFNET 4); refractory typical and atypical flutter and incessant focal AT; "pace and ablate" with CRT or conduction system pacing (APAF-CRT) and ensuring >98% biventricular pacing; urgent cardioversion; anticoagulation rules around cardioversion; LAA occlusion (PROTECT AF, PREVAIL, PRAGUE-17), surgical maze and hybrid ablation (LAAOS III); amiodarone, flecainide, sotalol and digoxin toxicity; pre-excited AF, HCM and congenital heart disease; the frail elderly (ELDERCARE-AF); and follow-up — illustrated with a tachycardia-induced cardiomyopathy whose EF recovered from 25% to 55% after ablation. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Cardiac Arrest in Acute MI with Mechanical Complications — Effective Management | 21 oct. 2026 | 00:45:15 | |
A patient with an acute myocardial infarction survives a cardiac arrest — and the heart is mechanically broken: a ruptured ventricular septum, a torn papillary muscle, or a rupture of the free wall. In this masterclass we cover how to recognise, stabilise and repair these patients while protecting the brain after the arrest. Topics include who is at risk (late presenters, unreperfused infarcts, older women, first MI) and the timing of rupture; how each mechanical complication causes or complicates an arrest; PEA, tamponade and ultrasound during resuscitation; parallel post-ROSC priorities for heart, circulation, lungs and brain; when to go to the cath lab (TOMAHAWK, COACT) and the value of angiography before surgery; ventricular septal rupture — diagnosis, oxygen step-up, IABP, the timing debate, and surgical or transcatheter closure; papillary muscle rupture — the soft or absent murmur, flash pulmonary oedema, emergency mitral surgery and rescue TEER; acute and subacute free wall rupture; true versus false LV aneurysm; choosing IABP, Impella or VA-ECMO for each lesion and LV venting; right ventricular infarction after an arrest; potent antiplatelets before emergency surgery and the role of cangrelor; temperature control and fever prevention (TTM2), seizures, and multimodal neuroprognostication at 72 hours; resuscitation injuries before anticoagulation; recurrent VF, VT and heart block; regional shock pathways and early transfer; long-term care, ICD timing, cardiac rehab and cognitive recovery; and prevention through early reperfusion — illustrated with a late inferior STEMI patient who survived VF arrest and papillary muscle rupture to walk home neurologically intact. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| After Bypass Surgery and SAVR — Complications and Management | 21 oct. 2026 | 00:46:37 | |
CABG and surgical aortic valve replacement are among the most effective operations in medicine — but the hours, days and weeks after surgery bring their own complications. In this masterclass we follow the post-operative timeline and show how to recognise and manage each one effectively: telling apart low cardiac output, vasoplegia, bleeding and tamponade in the first hours; epicardial pacing to optimise rate and rhythm; inotropes, IABP and mechanical support; refractory vasoplegia, vasopressin and methylene blue; bleeding thresholds, protamine, viscoelastic testing and early re-exploration; localised post-operative tamponade, blocked drains and the value of TEE; right ventricular failure and inhaled pulmonary vasodilators; cardiac arrest after cardiac surgery (CALS) — three stacked shocks, epicardial pacing and emergency resternotomy; type 5 (CABG-related) MI and early angiography for graft failure; post-operative atrial fibrillation, prevention with posterior pericardiotomy (PALACS) and LAA occlusion (LAAOS III), and when to anticoagulate; SAVR-specific complications — heart block and pacing, patient–prosthesis mismatch, paravalvular leak, prosthetic valve thrombosis and early endocarditis; anticoagulation for mechanical and bioprosthetic valves, On-X targets, and why DOACs must not be used with mechanical valves (RE-ALIGN, PROACT Xa); safe pacing-wire removal; late tamponade and postpericardiotomy syndrome (COPPS); stroke, delirium, AKI, fluid balance and glucose; sternal wound infection and mediastinitis; discharge therapy, DAPT and graft patency (DACAB), statins and cardiac rehab; recurrent angina and vein-graft failure; and SAVR versus TAVI (PARTNER, Evolut) — illustrated with a combined CABG and bioprosthetic AVR patient through AF, localised tamponade, complete heart block and postpericardiotomy syndrome. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Cath Lab Complications, Table Deaths and Sudden Death in Hospital — How to Handle Them Effectively | 21 oct. 2026 | 00:44:52 | |
Every interventional cardiologist fears it: a death on the cath lab table, or a patient who was talking in the morning and gone by evening. In this masterclass we examine why table deaths and in-hospital sudden deaths happen — and how many are predictable, preventable or survivable with preparation. Topics include the true risk of procedural death and the patients who carry it; the five families of table death (coronary catastrophes, arrhythmias, collapse in patients with no reserve, systemic events, and bleeding); heart-team planning, mechanical support on standby, bail-out equipment and the team time-out; reading the pressure tracing — damping and ventricularisation; flow-limiting and iatrogenic left main dissection; no-reflow and intracoronary vasodilators; coronary perforation (Ellis classification), balloon tamponade, dual-guide covered stents, coils and pericardiocentesis; ventricular fibrillation on the table, pre-applied pads, mechanical CPR (LUCAS) and ECPR (ARREST); bradycardia, vagal reactions and temporary pacing; contrast and protamine anaphylaxis and coronary air embolism; TAVI catastrophes — coronary obstruction, annular rupture, valve embolisation, LV perforation and large-bore vascular injury; stroke in the cath lab; contrast-associated kidney injury (POSEIDON, PRESERVE); retroperitoneal haemorrhage and the radial advantage; causes and timing of sudden death on the wards — arrhythmia, free wall rupture, PE, stent thrombosis, bleeding, missed dissection, over-sedation and raised potassium; failure to rescue, NEWS2 and rapid response teams; in-hospital cardiac arrest and post-arrest angiography (TOMAHAWK, COACT); talking to families, debriefing, M&M meetings and the "second victim" — illustrated with a guide-induced left main dissection with VF rescued on the table. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Post-MI Sepsis, Multiple Organ Failure and DIC — Effective Management | 21 oct. 2026 | 00:44:45 | |
A patient recovering from a myocardial infarction develops sepsis, then multiple organ failure, then disseminated intravascular coagulation — with a fresh stent that needs antiplatelets and a blood that is clotting and bleeding at once. In this masterclass we cover how to handle it safely and effectively: why post-MI patients become septic (lines, pacing wires, access sites, ventilation, aspiration, urine, C. difficile); separating post-infarction fever from true sepsis, and using procalcitonin wisely; Sepsis-3 and septic shock; the first hour — antibiotics within one hour, small reassessed fluid boluses in the infarcted heart, early norepinephrine, vasopressin and hydrocortisone; holding and later restarting post-MI medicines; aggressive source control and Staphylococcus aureus bacteraemia; the pathophysiology and phenotypes of DIC, the ISTH overt DIC score and the sepsis-induced coagulopathy (SIC) score; excluding HIT (4T score), TTP and drug-induced thrombocytopenia with a blood film; treating the cause, blood products for bleeding not numbers, fibrinogen targets, prophylactic heparin and why tranexamic acid is avoided in septic DIC (KyberSept, SCARLET); balancing a fresh stent against bleeding — aspirin and clopidogrel platelet thresholds, switching from ticagrelor or prasugrel, minimal TAT and early DAT (AUGUSTUS, PIONEER AF-PCI); preventing bleeding; organ interactions, citrate CRRT and ARDS; transfusion targets after MI (MINT, TRISS); why not to slow septic tachycardia (STRESS-L); recognising stent thrombosis versus type 2 MI, LV thrombus and mechanical complications; and communication — illustrated with an inferior STEMI patient whose infected femoral pacing-wire site led to S. aureus septic shock and DIC, and who went home on day 20. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Heart Disease with Multiple Organ Failure — Diagnosis and Management | 21 oct. 2026 | 00:44:26 | |
When the heart fails, it rarely fails alone. In this masterclass we cover the patient with heart disease and multiple organ failure — kidneys, lungs, liver, brain and blood — and how to break the vicious circle with a clear plan. Topics include the SOFA score and why mortality climbs with each failing organ; the first hour: ABC, shock type, reversible cause, organ support, lactate trends and point-of-care ultrasound; SCAI shock stages A–E; perfusion targets, norepinephrine first (SOAP II), dobutamine, milrinone and vasopressin; fluid as a test, congestion as an organ injury, and VExUS; pulmonary artery catheter, cardiac power output and PAPi; mechanical circulatory support after IABP-SHOCK II, DanGer Shock and ECLS-SHOCK, LV unloading and the shock team; cardiorenal syndrome, urine sodium–guided diuretics, ADVOR and CLOROTIC, and CRRT; non-invasive ventilation, safe intubation in shock and protecting the right ventricle; congestive hepatopathy versus shock liver, drug dosing and viscoelastic testing; post-arrest brain care (TTM2), stroke and delirium; thrombocytopenia, HIT and the bleeding–thrombosis balance; arrhythmias and electrical storm; sepsis and septic cardiomyopathy (LeoPARDS); daily medicine review, nutrition and care bundles; time-limited trials, goals of care and family communication — illustrated with a late anterior STEMI in shock (CULPRIT-SHOCK) who survived shock liver, dialysis and ventilation to walk home. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Heart Disease and Cancer — Cardiac Care During Cancer Treatment | 21 oct. 2026 | 00:45:25 | |
More patients than ever survive cancer — and many have heart disease before treatment or develop it during therapy. In this masterclass we cover cardiac care during cancer treatment, with one goal: keeping life-saving cancer therapy possible. Topics include the 2022 ESC cardio-oncology guideline and the HFA-ICOS baseline risk tool; ECG, echocardiography with global longitudinal strain, troponin and NT-proBNP at baseline; grading cancer therapy-related cardiac dysfunction (CTRCD); anthracycline cardiotoxicity, dexrazoxane, and cardioprotection with ACE inhibitors, carvedilol and statins (PRADA, CECCY, STOP-CA, SUCCOUR); HER2-targeted therapy and "permissive cardiotoxicity" (SAFE-HEaRt); immune checkpoint inhibitor myocarditis, the myositis–myasthenia overlap, and high-dose methylprednisolone; VEGF inhibitor and TKI hypertension and why to avoid diltiazem and verapamil; CYP3A4 and P-gp drug interactions; QTc monitoring with Fridericia; ibrutinib-related atrial fibrillation (ELEVATE-RR) and anticoagulation; fluoropyrimidine vasospasm; ponatinib, nilotinib, carfilzomib, osimertinib and CAR-T cytokine release syndrome; radiotherapy and mean heart dose; cancer-associated thrombosis (Hokusai VTE Cancer, SELECT-D, Caravaggio) and anticoagulation with thrombocytopenia; ACS and PCI in active cancer — SCAI platelet thresholds, radial access, short DAPT (LEADERS FREE, ONYX ONE, MASTER DAPT) and TAT/DAT (AUGUSTUS, PIONEER AF-PCI); recent stents before cancer surgery; TAVI in patients with cancer; pacemakers, ICDs and radiotherapy; heart failure therapy and sick-day rules; malignant pericardial effusion; and the multidisciplinary team — illustrated with a HER2-positive breast cancer case treated to remission with the heart protected. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| How to Write a Research Article, Thesis and Case Report — A Guide for UG, PG and Cardiology Fellows | 21 oct. 2026 | 00:46:25 | |
Every doctor sees patients worth writing about — but few are ever taught how to write. In this masterclass for undergraduates, postgraduate residents and cardiology fellows, we cover the complete path from a bedside observation to a published paper: what to aim for at each stage of training; finding a research question and testing it with FINER and PICO; a systematic literature search (PubMed, MeSH, Boolean operators) and reference managers; choosing the right study design; involving the statistician early and calculating sample size; ethics committee approval, informed consent, the Declaration of Helsinki, ICMR guidelines and trial registration (CTRI, ClinicalTrials.gov); planning a postgraduate thesis — timeline, protocol, chapters, data management with a codebook, working with your guide, and the commonest examiner criticisms; reporting effect sizes with confidence intervals; writing an original article in IMRAD format and the best order to write it; the reporting guidelines on the EQUATOR Network (CONSORT, STROBE, STARD, PRISMA, CARE, SQUIRE, SPIRIT); tables, figures and the central illustration; ICMJE authorship criteria; writing a case report with the CARE checklist, consent and de-identification; images, letters, audits and case series for beginners; choosing a journal and avoiding predatory publishers; cover letters, responding to reviewers and handling rejection; plagiarism and the responsible use of AI tools — illustrated with a resident's bleeding-risk study that went from question to publication in fourteen months. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Cardiac Care at 100 and Beyond — Treatment and Management of Centenarians and the Very Old | 12 oct. 2026 | 00:46:01 | |
More patients now live beyond 100 — and most of our guidelines stop at 75 or 80. In this masterclass we cover cardiac care for centenarians and the very old: the physiology of the ageing heart (arterial stiffness, diastolic dysfunction, conduction disease, blunted reserve) and the high prevalence of wild-type ATTR amyloid; comprehensive geriatric assessment, the Clinical Frailty Scale and goals of care; avoiding both ageism and over-treatment; deprescribing with STOPP/START and Beers criteria and dosing by Cockcroft-Gault; individualised blood pressure targets and orthostatic hypotension (HYVET, SPRINT); anticoagulation for atrial fibrillation with appropriately dosed DOACs, falls, and very-low-dose edoxaban (ELDERCARE-AF); HFpEF and gentle diuresis, SGLT2 inhibitors (EMPEROR-Preserved, DELIVER); TAVR in nonagenarians and centenarians and the risk of futile procedures; mitral and tricuspid TEER (COAPT, TRILUMINATE); acute coronary syndromes in the very old (After Eighty, SENIOR, MOSCA-FRAIL, POPular AGE), clopidogrel and short DAPT; bradyarrhythmias, leadless pacing, syncope and falls; why ICDs are rarely appropriate and the evidence gap for statins (STAREE, PREVENTABLE); dementia and capacity, CKD and anaemia; the hazards of hospitalisation and delirium; family caregiving in India; lifestyle at 100; and advance care planning — illustrated with a 101-year-old patient's case. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Tertiary Cardiac Care in the Final Days — Treatment and Management of the Dying Cardiac Patient | 12 oct. 2026 | 00:43:42 | |
We cannot always cure, but we can always care. In this masterclass we cover tertiary cardiac care for the critically ill patient in the final days of life: recognising the dying cardiac patient (refractory shock, progressive multi-organ failure, repeated arrests, mechanical support with no exit strategy), the surprise question and SPICT; excluding reversible causes and using time-limited trials; communicating serious news and leading family meetings with a SPIKES-based approach and substituted judgement; cultural, religious and legal considerations, including India's Common Cause judgment and advance directives; DNACPR decisions and ceilings of treatment; neuroprognostication after cardiac arrest; managing disagreement; withholding versus withdrawing life support and how to withdraw inotropes, mechanical ventilation, IABP, ECMO and dialysis; ICD shock deactivation and LVAD deactivation; expert symptom control for breathlessness, pain, anxiety, delirium and terminal secretions (opioids adjusted for renal function, midazolam, haloperidol, glycopyrronium), palliative sedation, rationalising cardiac medicines, nutrition and hydration; dying at home with anticipatory medicines; early advance care planning and palliative care (PAL-HF, ENABLE CHF-PC); organ donation; and bereavement and staff support — illustrated with a worked case. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Recurrent Heart Failure — Diagnosis, Treatment and Management | 12 oct. 2026 | 00:46:13 | |
Every readmission for heart failure is a signal that something has not been fixed. In this masterclass we cover recurrent and worsening heart failure from end to end: the definition of a worsening HF event and the HFrEF, HFmrEF, HFpEF and HFimpEF categories; a systematic search for precipitants (non-adherence, ischaemia, arrhythmia, hypertension, infection, renal dysfunction, harmful drugs, valve disease and under-treatment); diagnosis with clinical congestion and perfusion profiles, NT-proBNP trends, echocardiography, lung ultrasound, VExUS and cardiac MRI, including when to suspect ATTR amyloid; complete decongestion with adequately dosed IV loop diuretics, natriuresis-guided therapy and sequential nephron blockade (DOSE, PUSH-AHF, ADVOR, CLOROTIC); why a modest creatinine rise should not stop decongestion; the four pillars for HFrEF started in hospital and rapidly up-titrated (PARADIGM-HF, PIONEER-HF, DAPA-HF, EMPEROR-Reduced, EMPULSE, SOLOIST-WHF, STRONG-HF); vericiguat, ivabradine, digoxin and intravenous iron (VICTORIA, SHIFT, AFFIRM-AHF, IRONMAN); managing hyperkalaemia and low blood pressure; HFpEF therapy with SGLT2 inhibitors, finerenone and GLP-1–based therapy (EMPEROR-Preserved, DELIVER, FINEARTS-HF, STEP-HFpEF, SUMMIT); devices and interventions (CRT, ICD, CASTLE-AF, CASTLE-HTx, COAPT, STICH, REVIVED-BCIS2); remote monitoring (CHAMPION, GUIDE-HF, TIM-HF2); a safe transition home, salt and fluid advice (SODIUM-HF, FRESH-UP); realistic care in resource-limited settings (TRANSFORM-HF); recognising advanced heart failure with I NEED HELP; and palliative care — illustrated with a worked case. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| ECMO in Cardiac Care — Device Selection, Indications, Maintenance, Medications and Weaning | 12 oct. 2026 | 00:46:22 | |
ECMO buys time — but only if we choose the right patient, the right configuration and a clear destination. In this masterclass we cover the ECMO circuit, choosing veno-venous versus veno-arterial support (and hybrid V-A-V configurations), indications and contraindications, the SAVE and RESP scores, ultrasound-guided cannulation and the distal perfusion cannula, daily circuit management (flows, pressures, pre- and post-oxygenator gases, right radial monitoring and Harlequin syndrome), left ventricular distension and unloading with IABP or Impella (ECPELLA), anticoagulation with unfractionated heparin guided by anti-Xa levels, bivalirudin for HIT, DAPT in freshly stented patients, transfusion and haemolysis monitoring, sedation and antibiotic pharmacokinetics on the circuit, vasopressors and inotropes, weaning (flow-reduction trials with echo criteria for VA-ECMO and sweep-off trials for VV-ECMO), bridge to LVAD or transplant, palliative care, and care after decannulation — illustrated with a fulminant myocarditis case and the evidence from ECLS-SHOCK, CULPRIT-SHOCK, DanGer Shock, CESAR, EOLIA, ARREST, Prague OHCA and INCEPTION. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Host: Alexander Wood Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: • Cardiology books: https://cardiologybooks.com • Mentorship with the Academy of Elite Doctors: https://academyofelitedoctors.com • Online cardiology courses: https://cardiologycourse.com • World Elite Doctors: https://worldelitedoctors.com For medical education only. This episode is not a substitute for individual medical advice. | |||
| How Experts Think — Approaching Complex and Challenging Cases in Cardiology | 12 oct. 2026 | 00:44:25 | |
Over 58 episodes we have studied diseases. Today we study how an expert thinks. How do you approach the complex, challenging case that does not fit the textbook — the patient with a heart attack, kidney failure and a bleeding history all at once? We cover the four types of complexity, stabilising before thinking, applying trials wisely (is my patient the trial patient?), the Heart Team, cognitive traps such as anchoring and the oculostenotic reflex, risk scores, physiology and intravascular imaging, managing complications, shared decision-making and practice in resource-limited settings — with worked cases drawing on SYNTAX, EXCEL, ISCHEMIA, REVIVED, CULPRIT-SHOCK, DanGer Shock, AUGUSTUS, PIONEER AF-PCI, PARTNER, COAPT and STREAM. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| The Basic Skills That Master Complex and Challenging Cases in Cardiology | 12 oct. 2026 | 00:42:52 | |
The Basic Skills That Master Complex and Challenging Cases in Cardiology In our last episode we explored how an expert thinks. Today we go to the foundation underneath: the basic skills that win complex and challenging cases. We cover the investigative history (tempo, trigger, trajectory, background and every medicine), the purposeful examination, a systematic ECG read with the dangerous patterns, focused bedside echo, haemodynamics (pump, pipes, volume or rate), safe radial and ultrasound-guided femoral access, temporary pacing, pericardiocentesis, resuscitation and cardioversion, guide and wire handling, physiology and intravascular imaging, antithrombotic pharmacology and reversal, interpreting labs as trends, procedure planning with bail-out options, closed-loop communication, handover and documentation — drawing on RIVAL, MATRIX, FAME, DEFINE-FLAIR, iFR-SWEDEHEART, ULTIMATE, RENOVATE-COMPLEX-PCI, OCTOBER, EBC MAIN and DKCRUSH. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Host: Alexander Wood Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: • Cardiology books: https://cardiologybooks.com • Mentorship with the Academy of Elite Doctors: https://academyofelitedoctors.com • Online cardiology courses: https://cardiologycourse.com • World Elite Doctors: https://worldelitedoctors.com For medical education only. This episode is not a substitute for individual medical advice. | |||
| Resistant and Malignant Hypertension: Diagnosis, Current Guidelines, Treatment and Management | 11 oct. 2026 | 00:45:19 | |
In our last episode we covered hypertension and the current guidelines. Today we go deeper into the two most challenging forms: resistant hypertension, where blood pressure stays high despite multiple medicines, and malignant hypertension, a true medical emergency in which severely raised blood pressure damages the eyes, kidneys, brain and heart, sometimes within days. We'll cover definitions, how to uncover hidden causes, the step-by-step treatment of resistant hypertension including renal denervation and new drugs, and the emergency management of malignant hypertension. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Hypertension: Diagnosis, Current Guidelines, Treatment and Management | 11 oct. 2026 | 00:45:25 | |
Today's topic is the single most important modifiable risk factor for death worldwide: hypertension, or high blood pressure. It affects over a billion people, causes strokes, heart attacks, heart failure, kidney disease and dementia — and yet most people with it are either undiagnosed, untreated or poorly controlled. In the last two years, new European and American guidelines have changed how we define, measure and treat blood pressure, and exciting new treatments are arriving. We'll cover diagnosis, the current guidelines, treatment and long-term management. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Leadless Pacemaker Implantation: Treatment and Management | 11 oct. 2026 | 00:44:41 | |
In our recent episodes we've explored conduction disease, pacemaker modes and cardiac resynchronisation. Today we focus on one of the most remarkable innovations in device therapy: the leadless pacemaker. Imagine a complete pacemaker — battery, electronics and electrode — about the size of a large vitamin capsule, delivered through a vein in the leg and fixed directly inside the heart, with no wires and no surgical pocket. We'll cover how these devices work, who should receive them, how they are implanted, their complications, and how patients should be managed in the long term. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Cardiac Resynchronisation Therapy (CRT): Treatment and Management | 11 oct. 2026 | 00:45:02 | |
In our last episode we discussed conduction defects and pacemaker modes. Today we focus on one of the most important device therapies for heart failure: cardiac resynchronisation therapy, or CRT. For the right patient, it can transform breathlessness into an active life, shrink a dilated heart and reduce the risk of death. But around a third of patients don't respond as hoped. So who should receive CRT, how is it implanted, how do we make sure it works, and what are the new alternatives, such as conduction system pacing? Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Cardiac Conduction Defects and Pacemaker Mode Selection: Diagnosis, Treatment and Management | 11 oct. 2026 | 00:44:57 | |
Today we're exploring the heart's wiring — the conduction system — and what happens when it fails. Sinus node disease, heart block and bundle branch block can cause dizziness, fainting, heart failure and even sudden death. And the pacemaker, one of the greatest inventions in medicine, can restore a normal life. But which patients need a pacemaker, and which mode should we choose — single chamber, dual chamber, biventricular, conduction system pacing, or the new leadless devices? We'll cover diagnosis, temporary and permanent pacing, mode selection and long-term management. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Cardiac Ventricular Arrhythmias: Diagnosis, Treatment and Management | 11 oct. 2026 | 00:45:04 | |
In our last episode we explored the atrial arrhythmias. Today we move down to the ventricles, where arrhythmias can be the difference between life and death. Ventricular arrhythmias range from harmless extra beats to ventricular tachycardia, ventricular fibrillation and sudden cardiac death, which claims millions of lives worldwide every year. We'll cover the mechanisms, how to interpret the ECG, how to investigate the underlying heart, and how to treat — from the emergency department to the cath lab and the electrophysiology suite. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Cardiac Atrial Arrhythmias: Diagnosis, Treatment and Management | 11 oct. 2026 | 00:44:59 | |
Today we're focusing on the atrial arrhythmias — the rhythm disturbances that arise in the upper chambers of the heart. They range from harmless atrial ectopic beats to atrial tachycardia, atrial flutter and, most importantly, atrial fibrillation, the commonest sustained arrhythmia in the world and a major cause of stroke and heart failure. We'll cover how to recognise them on the ECG, how to investigate them, and how to treat and manage them using the latest guidelines and trials. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||
| Cardiac Antiarrhythmic Drugs: Classification, Mechanisms, Effects and Side Effects | 11 oct. 2026 | 00:45:19 | |
Today's topic is one that every doctor prescribes, every examiner asks about, and many of us find confusing: the antiarrhythmic drugs. How are they classified? How do they work at the level of the ion channels? When do we use them — and, just as importantly, when can they harm or even kill? From amiodarone and flecainide to beta-blockers, digoxin and adenosine, we'll cover classification, mechanisms, clinical effects and side effects. Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors. Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart. Learn more: For medical education only. This episode is not a substitute for individual medical advice. | |||