ABIM Advanced Heart Failure & Transplant
Cardiology Practice Exam Questions With
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant Download Pdf
1. Which of the following is the most common cause of advanced
heart failure in the United States?
A. Hypertrophic cardiomyopathy
B. Valvular heart disease
C. Ischemic cardiomyopathy
D. Restrictive cardiomyopathy
Answer: C. Ischemic cardiomyopathy
Rationale: Ischemic cardiomyopathy, resulting from prior myocardial
infarction and chronic coronary artery disease, is the leading cause of
advanced heart failure in the U.S.
2. A 62-year-old man with chronic systolic heart failure presents with
worsening dyspnea. His LVEF is 25%. Which guideline-directed
therapy has been shown to improve survival in HFrEF?
A. Loop diuretics
B. ACE inhibitors
C. Digoxin
D. Nitrates
Answer: B. ACE inhibitors
Rationale: ACE inhibitors reduce morbidity and mortality in HFrEF and
are a cornerstone of guideline-directed therapy. Loop diuretics provide
symptomatic relief but do not improve survival.
, 3. A patient with NYHA class III heart failure is being considered for
cardiac resynchronization therapy (CRT). Which ECG finding is
most indicative for CRT?
A. Right bundle branch block
B. Left bundle branch block with QRS >150 ms
C. First-degree AV block
D. Sinus tachycardia
Answer: B. Left bundle branch block with QRS >150 ms
Rationale: CRT is most effective in patients with LBBB and prolonged
QRS duration, improving symptoms, LVEF, and survival.
4. Which biomarker is most useful for diagnosing and monitoring
heart failure exacerbations?
A. Troponin I
B. B-type natriuretic peptide (BNP)
C. C-reactive protein
D. CK-MB
Answer: B. B-type natriuretic peptide (BNP)
Rationale: BNP and NT-proBNP are released in response to ventricular
stretch and correlate with heart failure severity and prognosis.
5. In advanced heart failure, which device therapy is indicated for
patients with persistent LVEF ≤35% and symptomatic despite
optimal medical therapy?
A. Pacemaker only
B. Implantable cardioverter-defibrillator (ICD)
C. External defibrillator
D. Vagal nerve stimulator
,Answer: B. Implantable cardioverter-defibrillator (ICD)
Rationale: ICDs reduce sudden cardiac death in patients with LVEF ≤35%
who remain symptomatic despite optimal therapy.
6. A patient with end-stage heart failure is being evaluated for heart
transplantation. Which comorbidity is generally considered an
absolute contraindication?
A. Diabetes mellitus
B. Chronic obstructive pulmonary disease
C. Active malignancy
D. Hypertension
Answer: C. Active malignancy
Rationale: Active malignancy carries high mortality risk and
immunosuppression after transplant can worsen cancer progression,
making it an absolute contraindication.
7. A 55-year-old patient with HFrEF is intolerant to ACE inhibitors due
to cough. What is the preferred alternative to improve survival?
A. ARB (angiotensin receptor blocker)
B. Hydralazine
C. Loop diuretic
D. Digoxin
Answer: A. ARB (angiotensin receptor blocker)
Rationale: ARBs provide similar mortality benefits as ACE inhibitors and
are used in patients who are ACE inhibitor intolerant.
8. Which of the following inotropes is commonly used as a bridge to
transplantation in patients with refractory cardiogenic shock?
A. Milrinone
B. Atenolol
, C. Lisinopril
D. Furosemide
Answer: A. Milrinone
Rationale: Milrinone is a phosphodiesterase-3 inhibitor that improves
cardiac output and reduces filling pressures, often used short-term in
advanced HF awaiting transplant.
9. A 48-year-old man with severe HFrEF develops hypotension and
worsening renal function despite IV diuretics. Which intervention
may be indicated?
A. Increase loop diuretic
B. Start digoxin
C. Mechanical circulatory support (e.g., LVAD)
D. Start beta-blocker
Answer: C. Mechanical circulatory support (e.g., LVAD)
Rationale: Patients with refractory symptoms and hemodynamic
compromise may require mechanical support as a bridge to transplant
or as destination therapy.
10. Which medication has been shown to reduce morbidity and
mortality specifically in African American patients with HFrEF?
A. ACE inhibitors
B. Beta-blockers
C. Hydralazine and isosorbide dinitrate
D. Loop diuretics
Answer: C. Hydralazine and isosorbide dinitrate
Rationale: The combination has been shown to reduce mortality and
hospitalizations in African American patients with HFrEF.
Cardiology Practice Exam Questions With
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant Download Pdf
1. Which of the following is the most common cause of advanced
heart failure in the United States?
A. Hypertrophic cardiomyopathy
B. Valvular heart disease
C. Ischemic cardiomyopathy
D. Restrictive cardiomyopathy
Answer: C. Ischemic cardiomyopathy
Rationale: Ischemic cardiomyopathy, resulting from prior myocardial
infarction and chronic coronary artery disease, is the leading cause of
advanced heart failure in the U.S.
2. A 62-year-old man with chronic systolic heart failure presents with
worsening dyspnea. His LVEF is 25%. Which guideline-directed
therapy has been shown to improve survival in HFrEF?
A. Loop diuretics
B. ACE inhibitors
C. Digoxin
D. Nitrates
Answer: B. ACE inhibitors
Rationale: ACE inhibitors reduce morbidity and mortality in HFrEF and
are a cornerstone of guideline-directed therapy. Loop diuretics provide
symptomatic relief but do not improve survival.
, 3. A patient with NYHA class III heart failure is being considered for
cardiac resynchronization therapy (CRT). Which ECG finding is
most indicative for CRT?
A. Right bundle branch block
B. Left bundle branch block with QRS >150 ms
C. First-degree AV block
D. Sinus tachycardia
Answer: B. Left bundle branch block with QRS >150 ms
Rationale: CRT is most effective in patients with LBBB and prolonged
QRS duration, improving symptoms, LVEF, and survival.
4. Which biomarker is most useful for diagnosing and monitoring
heart failure exacerbations?
A. Troponin I
B. B-type natriuretic peptide (BNP)
C. C-reactive protein
D. CK-MB
Answer: B. B-type natriuretic peptide (BNP)
Rationale: BNP and NT-proBNP are released in response to ventricular
stretch and correlate with heart failure severity and prognosis.
5. In advanced heart failure, which device therapy is indicated for
patients with persistent LVEF ≤35% and symptomatic despite
optimal medical therapy?
A. Pacemaker only
B. Implantable cardioverter-defibrillator (ICD)
C. External defibrillator
D. Vagal nerve stimulator
,Answer: B. Implantable cardioverter-defibrillator (ICD)
Rationale: ICDs reduce sudden cardiac death in patients with LVEF ≤35%
who remain symptomatic despite optimal therapy.
6. A patient with end-stage heart failure is being evaluated for heart
transplantation. Which comorbidity is generally considered an
absolute contraindication?
A. Diabetes mellitus
B. Chronic obstructive pulmonary disease
C. Active malignancy
D. Hypertension
Answer: C. Active malignancy
Rationale: Active malignancy carries high mortality risk and
immunosuppression after transplant can worsen cancer progression,
making it an absolute contraindication.
7. A 55-year-old patient with HFrEF is intolerant to ACE inhibitors due
to cough. What is the preferred alternative to improve survival?
A. ARB (angiotensin receptor blocker)
B. Hydralazine
C. Loop diuretic
D. Digoxin
Answer: A. ARB (angiotensin receptor blocker)
Rationale: ARBs provide similar mortality benefits as ACE inhibitors and
are used in patients who are ACE inhibitor intolerant.
8. Which of the following inotropes is commonly used as a bridge to
transplantation in patients with refractory cardiogenic shock?
A. Milrinone
B. Atenolol
, C. Lisinopril
D. Furosemide
Answer: A. Milrinone
Rationale: Milrinone is a phosphodiesterase-3 inhibitor that improves
cardiac output and reduces filling pressures, often used short-term in
advanced HF awaiting transplant.
9. A 48-year-old man with severe HFrEF develops hypotension and
worsening renal function despite IV diuretics. Which intervention
may be indicated?
A. Increase loop diuretic
B. Start digoxin
C. Mechanical circulatory support (e.g., LVAD)
D. Start beta-blocker
Answer: C. Mechanical circulatory support (e.g., LVAD)
Rationale: Patients with refractory symptoms and hemodynamic
compromise may require mechanical support as a bridge to transplant
or as destination therapy.
10. Which medication has been shown to reduce morbidity and
mortality specifically in African American patients with HFrEF?
A. ACE inhibitors
B. Beta-blockers
C. Hydralazine and isosorbide dinitrate
D. Loop diuretics
Answer: C. Hydralazine and isosorbide dinitrate
Rationale: The combination has been shown to reduce mortality and
hospitalizations in African American patients with HFrEF.
