ABFM HEART DISEASE ACTUAL EXAM WITH 100% RATED
CORRECT REAL EXAM QUESTIONS AND CORRECT ANSWERS|
GRADED A+ |2025 LATEST VERSION | 100% VERIFIED
A 65-year-old female who has heart failure with an ejection fraction of 35% is found to have a
TSH level of 13.8 µU/mL (N 0.3-4.82). Her T3 and T4 levels are normal, and her thyroid gland
is normal to palpation. You check her 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 - (ANSWER)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 subclinical hypothyroidism should be
treated with levothyroxine to improve their cardiovascular function and decrease the potential
risk of heart failure. Thyroxine in excess can exacerbate coronary artery disease, and should be
started at low doses and increased slowly in patients with possible underlying coronary artery
disease. Results of meta-analyses indicate that therapy will lower, not raise, serum LDL-
cholesterol levels.
A 58-year-old male is hospitalized with severe decompensated heart failure refractory to
intravenous inotropic therapy and guideline-directed medical therapy. You are considering
referral to a tertiary care hospital for mechanical circulatory support to bridge to
transplantation.Which one of the following is true regarding mechanical circulatory support
bridge therapy?
It should be limited to patients who meet the criteria for heart 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 - (ANSWER)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 ventricle, right
ventricle, or both.Bridge therapy refers to the use of left ventricular assist devices to help a
patient survive until a donor heart becomes available for transplantation. Several devices are
available, some of which are implantable and allow patients to be discharged to their homes.
These devices can increase patient activity levels and quality of life. Complications can occur,
including stroke, infection, and death, but these devices can be lifesaving in patients with
refractory heart failure.The data from the Interagency Registry for Mechanically Assisted
Circulatory Support indicates that cardiogenic shock, advanced age, and severe right heart failure
(manifested as ascites or increased bilirubin) are major risk factors for death after MCS. This led
to a recommendation that referral for MCS be considered before severe right ventricular failure
develops. Possible indications for a bridge-to-candidacy ventricular assist device include obesity,
tobacco use, and severe pulmonary hypertension in patients who might otherwise be candidates
for transplantation.
An active 66-year-old female presents with intermittent chest pain and dyspnea. She is currently
pain free. A resting EKG is normal.If found on the history and examination, which one of the
following symptoms is most likely to be associated with myocardial ischemia as the cause of
chest pain?
An episode of diaphoresis associated with the chest pain
Pain reproduced by chest wall palpation on the left side of the chest
Pain that comes and goes with and without exertion
Intermittent pleuritic-type pain and dyspnea - (ANSWER)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 EKG.Although they may be
present, pleuritic-type pain, pain reproduced with movement or palpation of the chest wall or
arm, and sharp or stabbing pain are not characteristic features of myocardial ischemia. Very brief
episodes of pain, lasting a few seconds or less, are also not characteristic of myocardial ischemia.
In a meta-analysis of symptoms useful in diagnosing acute coronary syndrome in a low-risk
setting, diaphoresis was found to be the strongest predictor of myocardial infarction (MI)
(likelihood ratio [LR] = 2.44), and the presence of chest wall tenderness significantly reduced the
possibility of MI (LR = 0.23). A completely normal EKG does not exclude the possibility of
acute coronary syndrome because 1%-6% of such patients eventually are found to have an acute
myocardial infarction (non-ST-segment elevation by definition) and at least 4% have unstable
angina.
A 69-year-old female with a history of chronic hypertension and a previous myocardial infarction
sees you for follow-up 6 weeks after being hospitalized for chest pain. During her hospitalization
she underwent cardiac catheterization, which showed only a lesion in the circumflex that was
less than 50% occluded. An EKG revealed sinus bradycardia of 52 beats/min, multifocal PVCs,
and a QRS interval of 0.10 sec. Echocardiography revealed a left ventricular ejection fraction of
32%.Although the patient feels comfortable at rest she reports that she has difficulty walking up
a single flight of stairs. Her current 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 - (ANSWER)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 trial) found that the addition of eplerenone in
heart failure patients with mild symptoms consistent with New York Heart Association (NYHA)
class II heart failure and a mean LVEF of 26% resulted in a reduction in both hospitalizations
and deaths. Current American Heart Association guidelines recommend the addition of an
aldosterone antagonist to an ACE inhibitor and a β-blocker in selected patients with moderately
severe to severe symptoms of heart failure and a reduced LVEF.Although the addition of digoxin
can be of benefit in selected heart failure patients by reducing the risk for hospitalization, it has
, not been shown to reduce mortality (SOR B). According to recent guidelines, patients are
considered candidates for cardiac resynchronization therapy if they have NYHA class II-IV heart
failure, a left ventricular ejection fraction ≤35%, and a QRS duration >130 ms on an EKG.
However, 30%-35% of patients who meet these criteria are nonresponders with no symptomatic
improvement or reverse left ventricular remodeling. Left bundle branch block morphology, a
QRS duration ≥150 ms, and adequate coronary sinus anatomy have been most closely associated
with a favorable response. Mitral valve regurgitation, right ventricular dysfunction, and atrial
fibrillation have been shown to have a negative impact on patient r
You admit a patient with acute coronary syndrome to the hospital. Which one of the following is
true regarding the differences between low molecular weight heparin (LMWH) and
unfractionated heparin (UFH) in this situation?
The use of glycoprotein IIb/IIIa inhibitors does not require a change in the dosage of UFH
The dosage of both should be titrated to achieve a partial thromboplastin time of 1.5-2.5 times
control
Platelet activation is the same for both
The incidence of thrombocytopenia is lower with LMWH
UFH has higher bioavailability because it is given intravenously - (ANSWER)D
Anticoagulation is recommended in addition to antiplatelet therapy for all patients with acute
coronary syndrome regardless of the initial treatment strategy. For patients managed with an
early invasive strategy, heparin exerts its anticoagulant effect by accelerating the action of
circulating antithrombin. It is available as either intravenous unfractionated heparin (UFH) or
subcutaneous low molecular weight heparin (LMWH).LMWH offers greater bioavailability than
UFH because of decreased binding to plasma proteins and endothelial cells, and it results in less
platelet activation. The incidence of thrombocytopenia in patients treated with LMWH is less
than with UFH. LMWH does not change the partial thromboplastin time (PTT) appreciably, so
PTT should not be used to monitor the dosage. LMWH is a viable option for treatment of acute
coronary artery syndrome and is preferred in many situations.If UFH is used it should be given
intravenously at a dosage of 85 U/kg unless a glycoprotein IIb/IIIa inhibitor is also administered,
in which case the dosage should be reduced to 60 U/kg. Dosing adjustments should be based on
the target activated clotting time. Patients treated with UFH should be monitored by factor Xa
assays.
CORRECT REAL EXAM QUESTIONS AND CORRECT ANSWERS|
GRADED A+ |2025 LATEST VERSION | 100% VERIFIED
A 65-year-old female who has heart failure with an ejection fraction of 35% is found to have a
TSH level of 13.8 µU/mL (N 0.3-4.82). Her T3 and T4 levels are normal, and her thyroid gland
is normal to palpation. You check her 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 - (ANSWER)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 subclinical hypothyroidism should be
treated with levothyroxine to improve their cardiovascular function and decrease the potential
risk of heart failure. Thyroxine in excess can exacerbate coronary artery disease, and should be
started at low doses and increased slowly in patients with possible underlying coronary artery
disease. Results of meta-analyses indicate that therapy will lower, not raise, serum LDL-
cholesterol levels.
A 58-year-old male is hospitalized with severe decompensated heart failure refractory to
intravenous inotropic therapy and guideline-directed medical therapy. You are considering
referral to a tertiary care hospital for mechanical circulatory support to bridge to
transplantation.Which one of the following is true regarding mechanical circulatory support
bridge therapy?
It should be limited to patients who meet the criteria for heart 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 - (ANSWER)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 ventricle, right
ventricle, or both.Bridge therapy refers to the use of left ventricular assist devices to help a
patient survive until a donor heart becomes available for transplantation. Several devices are
available, some of which are implantable and allow patients to be discharged to their homes.
These devices can increase patient activity levels and quality of life. Complications can occur,
including stroke, infection, and death, but these devices can be lifesaving in patients with
refractory heart failure.The data from the Interagency Registry for Mechanically Assisted
Circulatory Support indicates that cardiogenic shock, advanced age, and severe right heart failure
(manifested as ascites or increased bilirubin) are major risk factors for death after MCS. This led
to a recommendation that referral for MCS be considered before severe right ventricular failure
develops. Possible indications for a bridge-to-candidacy ventricular assist device include obesity,
tobacco use, and severe pulmonary hypertension in patients who might otherwise be candidates
for transplantation.
An active 66-year-old female presents with intermittent chest pain and dyspnea. She is currently
pain free. A resting EKG is normal.If found on the history and examination, which one of the
following symptoms is most likely to be associated with myocardial ischemia as the cause of
chest pain?
An episode of diaphoresis associated with the chest pain
Pain reproduced by chest wall palpation on the left side of the chest
Pain that comes and goes with and without exertion
Intermittent pleuritic-type pain and dyspnea - (ANSWER)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 EKG.Although they may be
present, pleuritic-type pain, pain reproduced with movement or palpation of the chest wall or
arm, and sharp or stabbing pain are not characteristic features of myocardial ischemia. Very brief
episodes of pain, lasting a few seconds or less, are also not characteristic of myocardial ischemia.
In a meta-analysis of symptoms useful in diagnosing acute coronary syndrome in a low-risk
setting, diaphoresis was found to be the strongest predictor of myocardial infarction (MI)
(likelihood ratio [LR] = 2.44), and the presence of chest wall tenderness significantly reduced the
possibility of MI (LR = 0.23). A completely normal EKG does not exclude the possibility of
acute coronary syndrome because 1%-6% of such patients eventually are found to have an acute
myocardial infarction (non-ST-segment elevation by definition) and at least 4% have unstable
angina.
A 69-year-old female with a history of chronic hypertension and a previous myocardial infarction
sees you for follow-up 6 weeks after being hospitalized for chest pain. During her hospitalization
she underwent cardiac catheterization, which showed only a lesion in the circumflex that was
less than 50% occluded. An EKG revealed sinus bradycardia of 52 beats/min, multifocal PVCs,
and a QRS interval of 0.10 sec. Echocardiography revealed a left ventricular ejection fraction of
32%.Although the patient feels comfortable at rest she reports that she has difficulty walking up
a single flight of stairs. Her current 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 - (ANSWER)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 trial) found that the addition of eplerenone in
heart failure patients with mild symptoms consistent with New York Heart Association (NYHA)
class II heart failure and a mean LVEF of 26% resulted in a reduction in both hospitalizations
and deaths. Current American Heart Association guidelines recommend the addition of an
aldosterone antagonist to an ACE inhibitor and a β-blocker in selected patients with moderately
severe to severe symptoms of heart failure and a reduced LVEF.Although the addition of digoxin
can be of benefit in selected heart failure patients by reducing the risk for hospitalization, it has
, not been shown to reduce mortality (SOR B). According to recent guidelines, patients are
considered candidates for cardiac resynchronization therapy if they have NYHA class II-IV heart
failure, a left ventricular ejection fraction ≤35%, and a QRS duration >130 ms on an EKG.
However, 30%-35% of patients who meet these criteria are nonresponders with no symptomatic
improvement or reverse left ventricular remodeling. Left bundle branch block morphology, a
QRS duration ≥150 ms, and adequate coronary sinus anatomy have been most closely associated
with a favorable response. Mitral valve regurgitation, right ventricular dysfunction, and atrial
fibrillation have been shown to have a negative impact on patient r
You admit a patient with acute coronary syndrome to the hospital. Which one of the following is
true regarding the differences between low molecular weight heparin (LMWH) and
unfractionated heparin (UFH) in this situation?
The use of glycoprotein IIb/IIIa inhibitors does not require a change in the dosage of UFH
The dosage of both should be titrated to achieve a partial thromboplastin time of 1.5-2.5 times
control
Platelet activation is the same for both
The incidence of thrombocytopenia is lower with LMWH
UFH has higher bioavailability because it is given intravenously - (ANSWER)D
Anticoagulation is recommended in addition to antiplatelet therapy for all patients with acute
coronary syndrome regardless of the initial treatment strategy. For patients managed with an
early invasive strategy, heparin exerts its anticoagulant effect by accelerating the action of
circulating antithrombin. It is available as either intravenous unfractionated heparin (UFH) or
subcutaneous low molecular weight heparin (LMWH).LMWH offers greater bioavailability than
UFH because of decreased binding to plasma proteins and endothelial cells, and it results in less
platelet activation. The incidence of thrombocytopenia in patients treated with LMWH is less
than with UFH. LMWH does not change the partial thromboplastin time (PTT) appreciably, so
PTT should not be used to monitor the dosage. LMWH is a viable option for treatment of acute
coronary artery syndrome and is preferred in many situations.If UFH is used it should be given
intravenously at a dosage of 85 U/kg unless a glycoprotein IIb/IIIa inhibitor is also administered,
in which case the dosage should be reduced to 60 U/kg. Dosing adjustments should be based on
the target activated clotting time. Patients treated with UFH should be monitored by factor Xa
assays.
