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.
Host: Alexander Wood

Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart.

Learn more:
• Cardiology books for doctors — Preventive Cardiology: The Cardiologist's Playbook, The Best Cardiac Diet, Advanced Diabetic Management and board review, with instant e-book downloads: 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.

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.
Host: Alexander Wood

Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart.

Learn more:
• Cardiology books for doctors — Transcatheter Edge-to-Edge Repair of the Mitral and Tricuspid Valves, Transcatheter Aortic Valve Replacement: Tricks and Tips, Interventional Cardiology Essentials and board review, with instant e-book downloads: 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.

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.
Host: Alexander Wood

Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart.

Learn more:
• Cardiology books for doctors — Cardio-Oncology Essentials, Echocardiography in Clinical Practice, Quick Notes in Practical Echocardiography and board review, with instant e-book downloads: 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.

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.
Host: Alexander Wood

Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart.

Learn more:
• Cardiology books for doctors — The Best Cardiac Diet, Advanced Diabetic Management, Cardiology for Every Specialty and board review, with instant e-book downloads: 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.

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.
Host: Alexander Wood

Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart.

Learn more:
• Cardiology books for doctors — Rheumatic Heart Disease: Care by Various Specialties, World Cardiology Essentials, Mastering Antibiotic Therapy and board review, with instant e-book downloads: 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.

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.
Host: Alexander Wood

Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart.

Learn more:
• Cardiology books for doctors — Transcatheter Aortic Valve Replacement: Tricks and Tips, Transcatheter Edge-to-Edge Repair of the Mitral and Tricuspid Valves, Interventional Cardiology Essentials and board review, with instant e-book downloads: 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.

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.
Host: Alexander Wood

Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart.

Learn more:
• Cardiology books for doctors — Comprehensive Critical Care and Emergency Drugs Monograph Handbook, Mastering Cardiac Emergencies, Arrhythmia Management and board review, with instant e-book downloads: 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 or local poison-centre guidance. If you are struggling, please reach out to someone you trust or a crisis helpline in your country.

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.
Host: Alexander Wood

Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart.

Learn more:
• Cardiology books for doctors — Beyond the Stethoscope, The Cardiologist's Black Book, Mastering Cardiac Emergencies and more, with instant e-book downloads: 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 general information, not legal advice; laws differ between countries and states — consult a qualified medicolegal adviser about your own situation.