1|Page
ABFM HEART DISEASE STUDY GUIDE LATEST
2025 | COMPREHENSIVE Q&A FOR
GUARANTEED SUCCESS
A 61-year-old male sees you for a follow-up visit. His medical history includes end-
stage heart failure, chronic atrial fibrillation, a left ventricular ejection fraction of
30%, and stage 4 chronic kidney disease. He is taking optimal dosages of lisinopril
(Prinivil, Zestril), metoprolol succinate (Toprol-XL), furosemide (Lasix), digoxin, and
spironolactone (Aldactone). He continues to have symptoms of heart failure with
minimal exertion, but not at rest. An EKG shows a ventricular rate of 85 beats/min,
a QRS duration of 0.14 sec, and old Q waves in the inferior leads.Appropriate
management options for this patient include which one of the following?
Adding a nondihydropyridine calcium channel blocker
Adding a thiazide diuretic
Switching from metoprolol succinate to metoprolol tartrate (Lopressor)
Synchronized biventricular pacing-correct-answer-D
Biventricular pacing with an implantable defibrillator can improve symptoms and
increase survival in heart failure patients with a prolonged QRS duration, and is
recommended for those with a low ejection fraction, given their increased risk for
ventricular fibrillation.Patients with refractory heart failure on optimal medical
therapy should be considered for a heart transplant. Patients with an anticipated
1-year survival probability <50% can benefit from left ventricular (LV) assist
devices. Patients who have a narrow QRS and stage D heart failure despite optimal
medical therapy, and who are not candidates for transplant or LV assist devices,
,2|Page
should not receive a defibrillator if their expected survival related to heart failure
or other comorbidities is less than 1-2 years, since a defibrillator will not improve
their survival.Changing from metoprolol succinate to metoprolol tartrate will not
be beneficial since the succinate form is the preferred formulation for heart
failure. Nondihydropyridine calcium channel blockers reduce the ejection fraction
and would therefore not be beneficial in this patient. Patients with severe heart
failure and severe chronic kidney disease generally do not respond favorably to
thiazide diuretics.
You see a 58-year-old male for a routine examination. According to the American
College of Cardiology/American Heart Association classification system, which one
of the following would meet the criteria for stage B heart failure, assuming he has
no additional complications?
A history of dyspnea on exertion
Well compensated heart failure
A grade 2/6 apical holosystolic murmur radiating to the axilla
Uncontrolled type 2 diabetes-correct-answer-C
A significant heart murmur, such as a grade 2/6 apical holosystolic murmur that
radiates to the axilla, is generally meaningful. The American College of
Cardiology/American Heart Association classification of heart failure includes four
stages. Stage A is defined as the absence of structural disease in a patient at high
risk for the development of heart failure. This includes patients with hypertension,
atherosclerotic disease, diabetes mellitus, obesity, metabolic syndrome, or a
family history of cardiomyopathy, as well as those using cardiotoxins. Patients with
stage B heart failure have evidence of structural heart disease, such as a previous
,3|Page
myocardial infarction, asymptomatic valvular disease, or evidence of left
ventricular remodeling such as left ventricular hypertrophy or a low ejection
fraction. Any patient with structural heart disease is at risk of heart failure and
should be managed aggressively to prevent complications in the future.Stage C is
defined as structural heart disease with prior or current symptoms of heart
failure. Patients with stage D heart failure have refractory heart failure requiring
specialized interventions.
A 61-year-old male sees you for a routine annual evaluation. A review of systems
is notable only for nocturia 1-2 times per night. He has a history of a non-ST-
elevation myocardial infarction 2 years ago treated with a drug-eluting stent. His
current medications are metoprolol tartrate (Lopressor), 50 mg twice daily;
hydrochlorothiazide, 25 mg daily; atorvastatin (Lipitor), 40 mg daily; aspirin, 81 mg
daily; and docusate as needed. He is a nonsmoker. His blood pressure is 132/82
mm Hg. A physical examination is normal.Which one of the following medications
is indicated at this time?
Diltiazem (Cardizem)
Enalapril (Vasotec)
Furosemide (Lasix)
Losartan (Cozaar)
Spironolactone (Aldactone)-correct-answer-B
Despite the absence of symptoms and a left ventricular ejection fraction within
the normal range, this patient's previous myocardial infarction (MI) is evidence of
structural heart disease, making his American College of Cardiology/American
Heart Association (ACC/AHA) heart failure classification stage B. Patients without
, 4|Page
heart failure symptoms who have had an MI or who have evidence of left
ventricular remodeling are thought to be at considerable risk of developing heart
failure and intervention is warranted. Patients who are at risk of future heart
failure should take an ACE inhibitor if they can tolerate it.In addition to optimal
management of hyperlipidemia and hypertension, the AHA recommends that ACE
inhibitors and β-blockers such as carvedilol, metoprolol succinate, or bisoprolol be
used in all patients with a recent or remote history of MI, regardless of ejection
fraction or the presence of heart failure (SOR A). Two large-scale studies have
demonstrated that prolonged therapy with an ACE inhibitor reduces the risk of a
major cardiovascular event even when treatment is initiated months or years after
the MI.Furosemide is not recommended for use in stage B patients, and calcium
channel blockers such as diltiazem can lead to worsening heart failure and should
be avoided. The AHA recommends that angiotensin receptor blockers be
administered to post-MI patients without heart failure who are intolerant of ACE
inhibitors and have a low left ventricular ejection fraction (SOR B). Aldosterone
antagonists would not be the first-line therapy for stage B heart failure.
A 74-year-old female is discharged from the hospital after being treated for an
exacerbation of heart failure with volume overload. She has a previous history of
coronary heart disease and hypertension. Her discharge medications include
furosemide (Lasix), 20 mg twice daily; lovastatin, 40 mg daily; ramipril (Altace), 5
mg daily; spironolactone (Aldactone), 12.5 mg twice daily; metoprolol succinate
(Toprol-XL), 75 mg daily; and aspirin, 81 mg daily. In addition, she is instructed to
avoid the use of ibuprofen and other NSAIDs and to add metolazone, 2.5 mg daily,
with 30 mL of 10% potassium chloride elixir on mornings when her weight is more
than 3 lb over her target weight of 130 lb.Which one of the following is the most
common reason for medication nonadherence in patients such as this?
Cost
ABFM HEART DISEASE STUDY GUIDE LATEST
2025 | COMPREHENSIVE Q&A FOR
GUARANTEED SUCCESS
A 61-year-old male sees you for a follow-up visit. His medical history includes end-
stage heart failure, chronic atrial fibrillation, a left ventricular ejection fraction of
30%, and stage 4 chronic kidney disease. He is taking optimal dosages of lisinopril
(Prinivil, Zestril), metoprolol succinate (Toprol-XL), furosemide (Lasix), digoxin, and
spironolactone (Aldactone). He continues to have symptoms of heart failure with
minimal exertion, but not at rest. An EKG shows a ventricular rate of 85 beats/min,
a QRS duration of 0.14 sec, and old Q waves in the inferior leads.Appropriate
management options for this patient include which one of the following?
Adding a nondihydropyridine calcium channel blocker
Adding a thiazide diuretic
Switching from metoprolol succinate to metoprolol tartrate (Lopressor)
Synchronized biventricular pacing-correct-answer-D
Biventricular pacing with an implantable defibrillator can improve symptoms and
increase survival in heart failure patients with a prolonged QRS duration, and is
recommended for those with a low ejection fraction, given their increased risk for
ventricular fibrillation.Patients with refractory heart failure on optimal medical
therapy should be considered for a heart transplant. Patients with an anticipated
1-year survival probability <50% can benefit from left ventricular (LV) assist
devices. Patients who have a narrow QRS and stage D heart failure despite optimal
medical therapy, and who are not candidates for transplant or LV assist devices,
,2|Page
should not receive a defibrillator if their expected survival related to heart failure
or other comorbidities is less than 1-2 years, since a defibrillator will not improve
their survival.Changing from metoprolol succinate to metoprolol tartrate will not
be beneficial since the succinate form is the preferred formulation for heart
failure. Nondihydropyridine calcium channel blockers reduce the ejection fraction
and would therefore not be beneficial in this patient. Patients with severe heart
failure and severe chronic kidney disease generally do not respond favorably to
thiazide diuretics.
You see a 58-year-old male for a routine examination. According to the American
College of Cardiology/American Heart Association classification system, which one
of the following would meet the criteria for stage B heart failure, assuming he has
no additional complications?
A history of dyspnea on exertion
Well compensated heart failure
A grade 2/6 apical holosystolic murmur radiating to the axilla
Uncontrolled type 2 diabetes-correct-answer-C
A significant heart murmur, such as a grade 2/6 apical holosystolic murmur that
radiates to the axilla, is generally meaningful. The American College of
Cardiology/American Heart Association classification of heart failure includes four
stages. Stage A is defined as the absence of structural disease in a patient at high
risk for the development of heart failure. This includes patients with hypertension,
atherosclerotic disease, diabetes mellitus, obesity, metabolic syndrome, or a
family history of cardiomyopathy, as well as those using cardiotoxins. Patients with
stage B heart failure have evidence of structural heart disease, such as a previous
,3|Page
myocardial infarction, asymptomatic valvular disease, or evidence of left
ventricular remodeling such as left ventricular hypertrophy or a low ejection
fraction. Any patient with structural heart disease is at risk of heart failure and
should be managed aggressively to prevent complications in the future.Stage C is
defined as structural heart disease with prior or current symptoms of heart
failure. Patients with stage D heart failure have refractory heart failure requiring
specialized interventions.
A 61-year-old male sees you for a routine annual evaluation. A review of systems
is notable only for nocturia 1-2 times per night. He has a history of a non-ST-
elevation myocardial infarction 2 years ago treated with a drug-eluting stent. His
current medications are metoprolol tartrate (Lopressor), 50 mg twice daily;
hydrochlorothiazide, 25 mg daily; atorvastatin (Lipitor), 40 mg daily; aspirin, 81 mg
daily; and docusate as needed. He is a nonsmoker. His blood pressure is 132/82
mm Hg. A physical examination is normal.Which one of the following medications
is indicated at this time?
Diltiazem (Cardizem)
Enalapril (Vasotec)
Furosemide (Lasix)
Losartan (Cozaar)
Spironolactone (Aldactone)-correct-answer-B
Despite the absence of symptoms and a left ventricular ejection fraction within
the normal range, this patient's previous myocardial infarction (MI) is evidence of
structural heart disease, making his American College of Cardiology/American
Heart Association (ACC/AHA) heart failure classification stage B. Patients without
, 4|Page
heart failure symptoms who have had an MI or who have evidence of left
ventricular remodeling are thought to be at considerable risk of developing heart
failure and intervention is warranted. Patients who are at risk of future heart
failure should take an ACE inhibitor if they can tolerate it.In addition to optimal
management of hyperlipidemia and hypertension, the AHA recommends that ACE
inhibitors and β-blockers such as carvedilol, metoprolol succinate, or bisoprolol be
used in all patients with a recent or remote history of MI, regardless of ejection
fraction or the presence of heart failure (SOR A). Two large-scale studies have
demonstrated that prolonged therapy with an ACE inhibitor reduces the risk of a
major cardiovascular event even when treatment is initiated months or years after
the MI.Furosemide is not recommended for use in stage B patients, and calcium
channel blockers such as diltiazem can lead to worsening heart failure and should
be avoided. The AHA recommends that angiotensin receptor blockers be
administered to post-MI patients without heart failure who are intolerant of ACE
inhibitors and have a low left ventricular ejection fraction (SOR B). Aldosterone
antagonists would not be the first-line therapy for stage B heart failure.
A 74-year-old female is discharged from the hospital after being treated for an
exacerbation of heart failure with volume overload. She has a previous history of
coronary heart disease and hypertension. Her discharge medications include
furosemide (Lasix), 20 mg twice daily; lovastatin, 40 mg daily; ramipril (Altace), 5
mg daily; spironolactone (Aldactone), 12.5 mg twice daily; metoprolol succinate
(Toprol-XL), 75 mg daily; and aspirin, 81 mg daily. In addition, she is instructed to
avoid the use of ibuprofen and other NSAIDs and to add metolazone, 2.5 mg daily,
with 30 mL of 10% potassium chloride elixir on mornings when her weight is more
than 3 lb over her target weight of 130 lb.Which one of the following is the most
common reason for medication nonadherence in patients such as this?
Cost
