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.
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.

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.
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.

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.
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.

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.

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.
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.

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.

How Experts Think — Approaching Complex and Challenging Cases in Cardiology

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.

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.