1
ABFM KSA Heart Disease Exam 2026/2027
Actual Exam - Complete Questions with
Detailed Rationales | 100% Verified Graded
A+ Pass Guaranteed - A+ Graded
Q1: A 65-year-old male presents with retrosternal chest pressure that occurs predictably when
walking up two flights of stairs and is relieved within 5 minutes of rest. He has no chest pain at
rest. His ECG is normal. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Non-cardiac chest pain
D. Prinzmetal angina
Correct Answer: B [CORRECT]
Rationale: Stable angina is characterized by chest discomfort that is predictable in onset,
provoked by exertion or stress, and relieved by rest or nitroglycerin within minutes. Unstable
angina (A) occurs at rest or with minimal exertion and is more severe/prolonged. Prinzmetal
angina (D) is caused by coronary vasospasm, often at rest, with transient ST elevation.
Q2: A patient with chronic stable angina is prescribed sublingual nitroglycerin. Which instruction
should the provider give regarding its use?
A. Take one tablet every 10 minutes for a maximum of three doses for ongoing chest pain.
B. Take one tablet prophylactically immediately before any physical activity.
C. Swallow the tablet whole with a full glass of water.
D. Store the tablets in a humid environment to prevent degradation.
Correct Answer: A [CORRECT]
Rationale: ACC/AHA guidelines for stable ischemic heart disease recommend taking 0.3 to 0.4
mg of sublingual nitroglycerin at the onset of chest pain, repeated every 5 minutes (up to 3
doses) if pain persists. Prophylactic use (B) is appropriate but not the primary instruction for
acute pain. Tablets should be kept in a dry, dark container (D) and allowed to dissolve under the
tongue (C).
,2
Q3: According to ACC/AHA guidelines, which of the following is first-line antianginal therapy
for patients with chronic stable angina who do not have contraindications?
A. Amlodipine
B. Ranolazine
C. Metoprolol
D. Long-acting nitrates
Correct Answer: C [CORRECT]
Rationale: Beta-blockers (e.g., metoprolol) are recommended as first-line antianginal therapy to
reduce myocardial oxygen demand by lowering heart rate and contractility. Calcium channel
blockers (A) or long-acting nitrates (D) are recommended if beta-blockers are contraindicated or
insufficient to control symptoms. Ranolazine (B) is reserved for refractory angina.
Q4: A 55-year-old female presents to the emergency department with substernal chest pain at rest
that started 2 hours ago. Her ECG shows 1 mm ST-segment depression in leads V1-V4. Initial
cardiac biomarkers (high-sensitivity troponin) are normal. What is the most appropriate
management?
A. Discharge with outpatient stress testing.
B. Admit for observation, repeat biomarkers in 3-6 hours, and initiate antiplatelet therapy.
C. Administer thrombolytics immediately.
D. Proceed directly to coronary angiography.
Correct Answer: B [CORRECT]
Rationale: This patient has Non-ST-Elevation Acute Coronary Syndrome (NSTEMI/Unstable
Angina). Management involves admission, serial ECGs and biomarkers (as troponin may take
hours to rise), and initiation of antiplatelet therapy (aspirin plus a P2Y12 inhibitor) and
anticoagulation. Thrombolytics (C) are indicated for STEMI, not NSTEMI.
Q5: A 70-year-old male with NSTEMI is scheduled for an early invasive strategy (coronary
angiography within 24 hours). Which antiplatelet regimen is recommended prior to the
procedure?
A. Aspirin 325 mg only
,3
B. Aspirin plus clopidogrel 600 mg loading dose
C. Aspirin plus ticagrelor 180 mg loading dose
D. Warfarin plus aspirin
Correct Answer: C [CORRECT]
Rationale: For NSTEMI patients managed with an early invasive strategy, current ACC/AHA
guidelines favor ticagrelor (or prasugrel) over clopidogrel in addition to aspirin, provided there is
no contraindication (e.g., prior intracranial hemorrhage), as they have greater and more
consistent platelet inhibition. Clopidogrel remains an option if ticagrelor/prasugrel are
contraindicated.
Q6: A 48-year-old male presents with severe crushing chest pain. His ECG shows ST-segment
elevation in leads II, III, and aVF. The catheterization lab is available on-site. What is the target
time from hospital arrival to balloon inflation (door-to-balloon time)?
A. Within 30 minutes
B. Within 60 minutes
C. Within 90 minutes
D. Within 120 minutes
Correct Answer: C [CORRECT]
Rationale: ACC/AHA guidelines for STEMI management mandate a door-to-balloon time of 90
minutes or less for patients presenting to a PCI-capable hospital. If the expected door-to-balloon
time exceeds 120 minutes, fibrinolytic therapy should be considered within 30 minutes of arrival
if no contraindications exist.
Q7: Which ECG finding is most specific for a Left Anterior Descending (LAD) artery occlusion
(anterior STEMI)?
A. ST elevation in leads II, III, aVF
B. ST elevation in leads V1-V6, I, aVL
C. ST elevation in leads V1-V2 only
D. ST depression in leads V1-V4
Correct Answer: B [CORRECT]
, 4
Rationale: ST elevation in the anterior leads (V1-V6) and lateral leads (I, aVL) indicates an
anterior wall MI, typically caused by an occlusion of the LAD. Inferior STEMI (A) involves the
right coronary artery. Posterior STEMI often presents as ST depression in V1-V4 (D). Isolated
V1-V2 elevation (C) can be a true posterior MI or a normal variant/Right Ventricular MI.
Q8: A patient is successfully treated for a STEMI with primary PCI and a drug-eluting stent is
placed. How long should dual antiplatelet therapy (DAPT) typically be continued?
A. 1 month
B. 3 months
C. 6 to 12 months
D. Lifelong
Correct Answer: C [CORRECT]
Rationale: For patients with acute coronary syndrome treated with PCI and a drug-eluting stent,
standard DAPT (aspirin plus a P2Y12 inhibitor) is recommended for at least 6 to 12 months,
depending on bleeding risk. Shorter durations (e.g., 1-3 months) are reserved for patients with
very high bleeding risk as evaluated by tools like the ARC-HBR risk score.
Q9: A 60-year-old male with a history of severe peripheral arterial disease presents with acute
STEMI. Fibrinolytic therapy is being considered. Which of the following is an absolute
contraindication to fibrinolysis?
A. Prior ischemic stroke more than 3 months ago
B. Current use of low-dose aspirin
C. Suspected aortic dissection
D. Age greater than 65
Correct Answer: C [CORRECT]
Rationale: Suspected aortic dissection is an absolute contraindication to fibrinolytic therapy
because giving a thrombolytic can cause fatal hemorrhage into the dissection or pericardial
tamponade. A prior stroke within 3 months (A) is a contraindication, but >3 months is relative.
Aspirin use (B) and age >65 (D) are not contraindications.
ABFM KSA Heart Disease Exam 2026/2027
Actual Exam - Complete Questions with
Detailed Rationales | 100% Verified Graded
A+ Pass Guaranteed - A+ Graded
Q1: A 65-year-old male presents with retrosternal chest pressure that occurs predictably when
walking up two flights of stairs and is relieved within 5 minutes of rest. He has no chest pain at
rest. His ECG is normal. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Non-cardiac chest pain
D. Prinzmetal angina
Correct Answer: B [CORRECT]
Rationale: Stable angina is characterized by chest discomfort that is predictable in onset,
provoked by exertion or stress, and relieved by rest or nitroglycerin within minutes. Unstable
angina (A) occurs at rest or with minimal exertion and is more severe/prolonged. Prinzmetal
angina (D) is caused by coronary vasospasm, often at rest, with transient ST elevation.
Q2: A patient with chronic stable angina is prescribed sublingual nitroglycerin. Which instruction
should the provider give regarding its use?
A. Take one tablet every 10 minutes for a maximum of three doses for ongoing chest pain.
B. Take one tablet prophylactically immediately before any physical activity.
C. Swallow the tablet whole with a full glass of water.
D. Store the tablets in a humid environment to prevent degradation.
Correct Answer: A [CORRECT]
Rationale: ACC/AHA guidelines for stable ischemic heart disease recommend taking 0.3 to 0.4
mg of sublingual nitroglycerin at the onset of chest pain, repeated every 5 minutes (up to 3
doses) if pain persists. Prophylactic use (B) is appropriate but not the primary instruction for
acute pain. Tablets should be kept in a dry, dark container (D) and allowed to dissolve under the
tongue (C).
,2
Q3: According to ACC/AHA guidelines, which of the following is first-line antianginal therapy
for patients with chronic stable angina who do not have contraindications?
A. Amlodipine
B. Ranolazine
C. Metoprolol
D. Long-acting nitrates
Correct Answer: C [CORRECT]
Rationale: Beta-blockers (e.g., metoprolol) are recommended as first-line antianginal therapy to
reduce myocardial oxygen demand by lowering heart rate and contractility. Calcium channel
blockers (A) or long-acting nitrates (D) are recommended if beta-blockers are contraindicated or
insufficient to control symptoms. Ranolazine (B) is reserved for refractory angina.
Q4: A 55-year-old female presents to the emergency department with substernal chest pain at rest
that started 2 hours ago. Her ECG shows 1 mm ST-segment depression in leads V1-V4. Initial
cardiac biomarkers (high-sensitivity troponin) are normal. What is the most appropriate
management?
A. Discharge with outpatient stress testing.
B. Admit for observation, repeat biomarkers in 3-6 hours, and initiate antiplatelet therapy.
C. Administer thrombolytics immediately.
D. Proceed directly to coronary angiography.
Correct Answer: B [CORRECT]
Rationale: This patient has Non-ST-Elevation Acute Coronary Syndrome (NSTEMI/Unstable
Angina). Management involves admission, serial ECGs and biomarkers (as troponin may take
hours to rise), and initiation of antiplatelet therapy (aspirin plus a P2Y12 inhibitor) and
anticoagulation. Thrombolytics (C) are indicated for STEMI, not NSTEMI.
Q5: A 70-year-old male with NSTEMI is scheduled for an early invasive strategy (coronary
angiography within 24 hours). Which antiplatelet regimen is recommended prior to the
procedure?
A. Aspirin 325 mg only
,3
B. Aspirin plus clopidogrel 600 mg loading dose
C. Aspirin plus ticagrelor 180 mg loading dose
D. Warfarin plus aspirin
Correct Answer: C [CORRECT]
Rationale: For NSTEMI patients managed with an early invasive strategy, current ACC/AHA
guidelines favor ticagrelor (or prasugrel) over clopidogrel in addition to aspirin, provided there is
no contraindication (e.g., prior intracranial hemorrhage), as they have greater and more
consistent platelet inhibition. Clopidogrel remains an option if ticagrelor/prasugrel are
contraindicated.
Q6: A 48-year-old male presents with severe crushing chest pain. His ECG shows ST-segment
elevation in leads II, III, and aVF. The catheterization lab is available on-site. What is the target
time from hospital arrival to balloon inflation (door-to-balloon time)?
A. Within 30 minutes
B. Within 60 minutes
C. Within 90 minutes
D. Within 120 minutes
Correct Answer: C [CORRECT]
Rationale: ACC/AHA guidelines for STEMI management mandate a door-to-balloon time of 90
minutes or less for patients presenting to a PCI-capable hospital. If the expected door-to-balloon
time exceeds 120 minutes, fibrinolytic therapy should be considered within 30 minutes of arrival
if no contraindications exist.
Q7: Which ECG finding is most specific for a Left Anterior Descending (LAD) artery occlusion
(anterior STEMI)?
A. ST elevation in leads II, III, aVF
B. ST elevation in leads V1-V6, I, aVL
C. ST elevation in leads V1-V2 only
D. ST depression in leads V1-V4
Correct Answer: B [CORRECT]
, 4
Rationale: ST elevation in the anterior leads (V1-V6) and lateral leads (I, aVL) indicates an
anterior wall MI, typically caused by an occlusion of the LAD. Inferior STEMI (A) involves the
right coronary artery. Posterior STEMI often presents as ST depression in V1-V4 (D). Isolated
V1-V2 elevation (C) can be a true posterior MI or a normal variant/Right Ventricular MI.
Q8: A patient is successfully treated for a STEMI with primary PCI and a drug-eluting stent is
placed. How long should dual antiplatelet therapy (DAPT) typically be continued?
A. 1 month
B. 3 months
C. 6 to 12 months
D. Lifelong
Correct Answer: C [CORRECT]
Rationale: For patients with acute coronary syndrome treated with PCI and a drug-eluting stent,
standard DAPT (aspirin plus a P2Y12 inhibitor) is recommended for at least 6 to 12 months,
depending on bleeding risk. Shorter durations (e.g., 1-3 months) are reserved for patients with
very high bleeding risk as evaluated by tools like the ARC-HBR risk score.
Q9: A 60-year-old male with a history of severe peripheral arterial disease presents with acute
STEMI. Fibrinolytic therapy is being considered. Which of the following is an absolute
contraindication to fibrinolysis?
A. Prior ischemic stroke more than 3 months ago
B. Current use of low-dose aspirin
C. Suspected aortic dissection
D. Age greater than 65
Correct Answer: C [CORRECT]
Rationale: Suspected aortic dissection is an absolute contraindication to fibrinolytic therapy
because giving a thrombolytic can cause fatal hemorrhage into the dissection or pericardial
tamponade. A prior stroke within 3 months (A) is a contraindication, but >3 months is relative.
Aspirin use (B) and age >65 (D) are not contraindications.
