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.