ABFM Heart Disease Study Guide 2025/2026 with Solution High-Yield Questions for Exam Success
C
Clinical hypothyroidism has long been associated with
cardiac dysfunction. It has also been shown that subclinical
hypothyroidism (TSH >4 µU/mL with normal or borderline
low thyroid hormone levels) can cause left ventricular
systolic and diastolic dysfunction, which improves with
thyroid replacement therapy. Patients with overt or
A 65-year-old female who has subclinical hypothyroidism should be treated with
heart failure with an ejection levothyroxine to improve their cardiovascular function and
fraction of 35% is found to decrease the potential risk of heart failure. Thyroxine in
have a TSH level of 13.8 excess can exacerbate coronary artery disease, and should be
µU/mL (N 0.3-4.82). Her T3 started at low doses and increased slowly in patients with
and T4 levels are normal, and possible underlying coronary artery disease. Results of meta-
her thyroid gland is normal to analyses indicate that therapy will lower, not raise, serum
palpation. You check her LDL-cholesterol levels.
levels again in 2 months and
they are unchanged. You
advise her that
hypothyroidism decreases her
metabolic rate, which reduces
the stress on her heart
hypothyroidism is detrimental
to her heart only if she
develops hypothyroid
symptoms
subclinical hypothyroidism
has negative effects on heart
failure and treatment should
be considered
treatment of subclinical
hypothyroidism would raise
her LDL-cholesterol level
2025/11/10
,ABFM Heart Disease Study Guide 2025/2026 with Solution High-Yield Questions for Exam Success
c
Mechanical circulatory support (MCS) with a ventricular
assist device has continued to evolve and has emerged as a
viable therapeutic option for patients with advanced stage D
heart failure with reduced ejection fraction refractory to
guideline-directed medical therapy and cardiac device
intervention. A variety of ventricular assist devices are now
available. These devices may be either intracorporeal or
extracorporeal, and may be designed to assist the left
A 58-year-old male is ventricle, right ventricle, or both.Bridge therapy refers to the
hospitalized with severe use of left ventricular assist devices to help a patient survive
decompensated heart failure until a donor heart becomes available for transplantation.
refractory to intravenous Several devices are available, some of which are implantable
inotropic therapy and and allow patients to be discharged to their homes. These
guideline-directed medical devices can increase patient activity levels and quality of life.
therapy. You are considering Complications can occur, including stroke, infection, and
referral to a tertiary care death, but these devices can be lifesaving in patients with
hospital for mechanical refractory heart failure.The data from the Interagency
circulatory support to bridge Registry for Mechanically Assisted Circulatory Support
to transplantation.Which one indicates that cardiogenic shock, advanced age, and severe
of the following is true right heart failure (manifested as ascites or increased
regarding mechanical bilirubin) are major risk factors for death after MCS. This led
circulatory support bridge to a recommendation that referral for MCS be considered
therapy? before severe right ventricular failure develops. Possible
indications for a bridge-to-candidacy ventricular assist device
It should be limited to patients include obesity, tobacco use, and severe pulmonary
who meet the criteria for heart hypertension in patients who might otherwise be candidates
transplantation for transplantation.
It should only be used in
patients with biventricular
heart failure
It generally improves quality
of life while waiting for
transplantation
It greatly reduces quality of
life while waiting for
transplantation
2025/11/10
,ABFM Heart Disease Study Guide 2025/2026 with Solution High-Yield Questions for Exam Success
A
Cardiac ischemia is classically defined as deep, poorly
localized chest or arm discomfort reproducibly associated
with exertion or emotional stress. It is relieved with rest and
nitroglycerin. It can present in an atypical fashion, and the
discomfort can localize or radiate to the neck, lower jaw,
throat, shoulder, epigastrium, hands, or upper back. It may be
entirely absent in some cases. In older patients without chest
pain, new-onset or unexplained exertional dyspnea is the
most common anginal equivalent, even with a normal resting
An active 66-year-old female EKG.Although they may be present, pleuritic-type pain, pain
presents with intermittent reproduced with movement or palpation of the chest wall or
chest pain and dyspnea. She is arm, and sharp or stabbing pain are not characteristic features
currently pain free. A resting of myocardial ischemia. Very brief episodes of pain, lasting a
EKG is normal.If found on few seconds or less, are also not characteristic of myocardial
the history and examination, ischemia. In a meta-analysis of symptoms useful in
which one of the following diagnosing acute coronary syndrome in a low-risk setting,
symptoms is most likely to be diaphoresis was found to be the strongest predictor of
associated with myocardial myocardial infarction (MI) (likelihood ratio [LR] = 2.44),
ischemia as the cause of chest and the presence of chest wall tenderness significantly
pain? reduced the possibility of MI (LR = 0.23). A completely
normal EKG does not exclude the possibility of acute
An episode of diaphoresis coronary syndrome because 1%-6% of such patients
associated with the chest pain eventually are found to have an acute myocardial infarction
Pain reproduced by chest wall (non-ST-segment elevation by definition) and at least 4%
palpation on the left side of have unstable angina.
the chest
Pain that comes and goes with
and without exertion
Intermittent pleuritic-type
pain and dyspnea
2025/11/10
, ABFM Heart Disease Study Guide 2025/2026 with Solution High-Yield Questions for Exam Success
D
Aldosterone antagonists are important in the management of
severe heart failure. The addition of an aldosterone
antagonist to a β-blocker and an ACE inhibitor was shown in
the Randomized Aldactone Evaluation Study to reduce rates
of death and hospital readmissions in selected patients with
moderate to severe symptoms of heart failure and a reduced
left ventricular ejection fraction (LVEF) (SOR B). More
recently, the EMPHASIS-HF trial (Eplerenone in Mild
Patients Hospitalization and Survival Study in Heart Failure
A 69-year-old female with a trial) found that the addition of eplerenone in heart failure
history of chronic patients with mild symptoms consistent with New York Heart
hypertension and a previous Association (NYHA) class II heart failure and a mean LVEF
myocardial infarction sees of 26% resulted in a reduction in both hospitalizations and
you for follow-up 6 weeks deaths. Current American Heart Association guidelines
after being hospitalized for recommend the addition of an aldosterone antagonist to an
chest pain. During her ACE inhibitor and a β-blocker in selected patients with
hospitalization she underwent moderately severe to severe symptoms of heart failure and a
cardiac catheterization, which reduced LVEF.Although the addition of digoxin can be of
showed only a lesion in the benefit in selected heart failure patients by reducing the risk
circumflex that was less than for hospitalization, it has not been shown to reduce mortality
50% occluded. An EKG (SOR B). According to recent guidelines, patients are
revealed sinus bradycardia of considered candidates for cardiac resynchronization therapy
52 beats/min, multifocal if they have NYHA class II-IV heart failure, a left ventricular
PVCs, and a QRS interval of ejection fraction ≤35%, and a QRS duration >130 ms on an
0.10 sec. Echocardiography EKG. However, 30%-35% of patients who meet these criteria
revealed a left ventricular are nonresponders with no symptomatic improvement or
ejection fraction of reverse left ventricular remodeling. Left bundle branch block
32%.Although the patient morphology, a QRS duration ≥150 ms, and adequate
feels comfortable at rest she coronary sinus anatomy have been most closely associated
reports that she has difficulty with a favorable response. Mitral valve regurgitation, right
walking up a single flight of ventricular dysfunction, and atrial fibrillation have been
stairs. Her current shown to have a negative impact on patient r
medications include
atorvastatin (Lipitor), 40 mg
daily; lisinopril (Prinivil,
Zestril), 20 mg daily;
metoprolol succinate (Toprol-
XL), 100 mg daily;
furosemide (Lasix), 40 mg
daily; and aspirin, 81 mg
daily.On examination the
patient is not in acute distress.
Her blood pressure is 132/78
mm Hg and her pulse rate
2025/11/10
C
Clinical hypothyroidism has long been associated with
cardiac dysfunction. It has also been shown that subclinical
hypothyroidism (TSH >4 µU/mL with normal or borderline
low thyroid hormone levels) can cause left ventricular
systolic and diastolic dysfunction, which improves with
thyroid replacement therapy. Patients with overt or
A 65-year-old female who has subclinical hypothyroidism should be treated with
heart failure with an ejection levothyroxine to improve their cardiovascular function and
fraction of 35% is found to decrease the potential risk of heart failure. Thyroxine in
have a TSH level of 13.8 excess can exacerbate coronary artery disease, and should be
µU/mL (N 0.3-4.82). Her T3 started at low doses and increased slowly in patients with
and T4 levels are normal, and possible underlying coronary artery disease. Results of meta-
her thyroid gland is normal to analyses indicate that therapy will lower, not raise, serum
palpation. You check her LDL-cholesterol levels.
levels again in 2 months and
they are unchanged. You
advise her that
hypothyroidism decreases her
metabolic rate, which reduces
the stress on her heart
hypothyroidism is detrimental
to her heart only if she
develops hypothyroid
symptoms
subclinical hypothyroidism
has negative effects on heart
failure and treatment should
be considered
treatment of subclinical
hypothyroidism would raise
her LDL-cholesterol level
2025/11/10
,ABFM Heart Disease Study Guide 2025/2026 with Solution High-Yield Questions for Exam Success
c
Mechanical circulatory support (MCS) with a ventricular
assist device has continued to evolve and has emerged as a
viable therapeutic option for patients with advanced stage D
heart failure with reduced ejection fraction refractory to
guideline-directed medical therapy and cardiac device
intervention. A variety of ventricular assist devices are now
available. These devices may be either intracorporeal or
extracorporeal, and may be designed to assist the left
A 58-year-old male is ventricle, right ventricle, or both.Bridge therapy refers to the
hospitalized with severe use of left ventricular assist devices to help a patient survive
decompensated heart failure until a donor heart becomes available for transplantation.
refractory to intravenous Several devices are available, some of which are implantable
inotropic therapy and and allow patients to be discharged to their homes. These
guideline-directed medical devices can increase patient activity levels and quality of life.
therapy. You are considering Complications can occur, including stroke, infection, and
referral to a tertiary care death, but these devices can be lifesaving in patients with
hospital for mechanical refractory heart failure.The data from the Interagency
circulatory support to bridge Registry for Mechanically Assisted Circulatory Support
to transplantation.Which one indicates that cardiogenic shock, advanced age, and severe
of the following is true right heart failure (manifested as ascites or increased
regarding mechanical bilirubin) are major risk factors for death after MCS. This led
circulatory support bridge to a recommendation that referral for MCS be considered
therapy? before severe right ventricular failure develops. Possible
indications for a bridge-to-candidacy ventricular assist device
It should be limited to patients include obesity, tobacco use, and severe pulmonary
who meet the criteria for heart hypertension in patients who might otherwise be candidates
transplantation for transplantation.
It should only be used in
patients with biventricular
heart failure
It generally improves quality
of life while waiting for
transplantation
It greatly reduces quality of
life while waiting for
transplantation
2025/11/10
,ABFM Heart Disease Study Guide 2025/2026 with Solution High-Yield Questions for Exam Success
A
Cardiac ischemia is classically defined as deep, poorly
localized chest or arm discomfort reproducibly associated
with exertion or emotional stress. It is relieved with rest and
nitroglycerin. It can present in an atypical fashion, and the
discomfort can localize or radiate to the neck, lower jaw,
throat, shoulder, epigastrium, hands, or upper back. It may be
entirely absent in some cases. In older patients without chest
pain, new-onset or unexplained exertional dyspnea is the
most common anginal equivalent, even with a normal resting
An active 66-year-old female EKG.Although they may be present, pleuritic-type pain, pain
presents with intermittent reproduced with movement or palpation of the chest wall or
chest pain and dyspnea. She is arm, and sharp or stabbing pain are not characteristic features
currently pain free. A resting of myocardial ischemia. Very brief episodes of pain, lasting a
EKG is normal.If found on few seconds or less, are also not characteristic of myocardial
the history and examination, ischemia. In a meta-analysis of symptoms useful in
which one of the following diagnosing acute coronary syndrome in a low-risk setting,
symptoms is most likely to be diaphoresis was found to be the strongest predictor of
associated with myocardial myocardial infarction (MI) (likelihood ratio [LR] = 2.44),
ischemia as the cause of chest and the presence of chest wall tenderness significantly
pain? reduced the possibility of MI (LR = 0.23). A completely
normal EKG does not exclude the possibility of acute
An episode of diaphoresis coronary syndrome because 1%-6% of such patients
associated with the chest pain eventually are found to have an acute myocardial infarction
Pain reproduced by chest wall (non-ST-segment elevation by definition) and at least 4%
palpation on the left side of have unstable angina.
the chest
Pain that comes and goes with
and without exertion
Intermittent pleuritic-type
pain and dyspnea
2025/11/10
, ABFM Heart Disease Study Guide 2025/2026 with Solution High-Yield Questions for Exam Success
D
Aldosterone antagonists are important in the management of
severe heart failure. The addition of an aldosterone
antagonist to a β-blocker and an ACE inhibitor was shown in
the Randomized Aldactone Evaluation Study to reduce rates
of death and hospital readmissions in selected patients with
moderate to severe symptoms of heart failure and a reduced
left ventricular ejection fraction (LVEF) (SOR B). More
recently, the EMPHASIS-HF trial (Eplerenone in Mild
Patients Hospitalization and Survival Study in Heart Failure
A 69-year-old female with a trial) found that the addition of eplerenone in heart failure
history of chronic patients with mild symptoms consistent with New York Heart
hypertension and a previous Association (NYHA) class II heart failure and a mean LVEF
myocardial infarction sees of 26% resulted in a reduction in both hospitalizations and
you for follow-up 6 weeks deaths. Current American Heart Association guidelines
after being hospitalized for recommend the addition of an aldosterone antagonist to an
chest pain. During her ACE inhibitor and a β-blocker in selected patients with
hospitalization she underwent moderately severe to severe symptoms of heart failure and a
cardiac catheterization, which reduced LVEF.Although the addition of digoxin can be of
showed only a lesion in the benefit in selected heart failure patients by reducing the risk
circumflex that was less than for hospitalization, it has not been shown to reduce mortality
50% occluded. An EKG (SOR B). According to recent guidelines, patients are
revealed sinus bradycardia of considered candidates for cardiac resynchronization therapy
52 beats/min, multifocal if they have NYHA class II-IV heart failure, a left ventricular
PVCs, and a QRS interval of ejection fraction ≤35%, and a QRS duration >130 ms on an
0.10 sec. Echocardiography EKG. However, 30%-35% of patients who meet these criteria
revealed a left ventricular are nonresponders with no symptomatic improvement or
ejection fraction of reverse left ventricular remodeling. Left bundle branch block
32%.Although the patient morphology, a QRS duration ≥150 ms, and adequate
feels comfortable at rest she coronary sinus anatomy have been most closely associated
reports that she has difficulty with a favorable response. Mitral valve regurgitation, right
walking up a single flight of ventricular dysfunction, and atrial fibrillation have been
stairs. Her current shown to have a negative impact on patient r
medications include
atorvastatin (Lipitor), 40 mg
daily; lisinopril (Prinivil,
Zestril), 20 mg daily;
metoprolol succinate (Toprol-
XL), 100 mg daily;
furosemide (Lasix), 40 mg
daily; and aspirin, 81 mg
daily.On examination the
patient is not in acute distress.
Her blood pressure is 132/78
mm Hg and her pulse rate
2025/11/10
