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.