Heart Failure Certification (HF‑C) Practice Exam – 2026
Edition
Complete practice exam with verified ANSWERS
Section 1 – Etiology, Anatomy & Pathophysiology (Q1–20)
1. Which of the following is the most common cause of heart failure in developed countries?
A. Hypertension – important contributor, but second to ischemic disease.
B. Coronary artery disease – correct: ischemic myocardial injury impairs cardiac function.
C. Valvular heart disease – less common etiology in developed nations.
D. Viral myocarditis – uncommon, sporadic cause.
ANSWER: B
2. A patient presents with dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Which
type of heart failure is most likely?
A. Right‑sided heart failure – produces systemic congestion (edema, JVD), not pulmonary symptoms.
B. High‑output heart failure – rare hyperdynamic state (anemia, thyrotoxicosis).
C. Left‑sided heart failure – correct: pulmonary venous congestion causes these classic symptoms.
D. Constrictive pericarditis – presents with predominant right‑sided signs.
ANSWER: C
3. Which biomarker is most useful for diagnosing and prognosticating heart failure?
A. Troponin I – marks myocyte injury, not volume overload.
B. CK‑MB – low specificity for heart failure.
C. C‑reactive protein – inflammatory marker, nonspecific.
D. B‑type natriuretic peptide (BNP) – correct: released with ventricular wall stress; correlates with
severity.
ANSWER: D
4. What is the mechanism of action of ACE inhibitors in heart failure?
,A. Increase heart rate – incorrect; heart rate is unchanged or slightly reduced.
B. Block beta‑adrenergic receptors – that is the beta‑blocker mechanism.
C. Decrease afterload and preload by inhibiting angiotensin II formation – correct.
D. Promote sodium retention – opposite of the desired effect.
ANSWER: C
5. The primary function of the left ventricle is to:
A. Receive systemic venous return – function of the right atrium.
B. Pump oxygenated blood to the systemic circulation – correct.
C. Pump blood to the lungs – function of the right ventricle.
D. Drain coronary venous blood – function of the coronary sinus.
ANSWER: B
6. HFrEF is defined by:
A. EF ≥50% with stiff ventricle – describes HFpEF.
B. EF ≤40% with impaired systolic contraction – correct.
C. Normal EF with high output – high‑output failure.
D. Pericardial thickening – constrictive pericarditis.
ANSWER: B
7. The primary defect in HFpEF is:
A. Reduced contractility – feature of HFrEF.
B. Impaired relaxation and diastolic filling – correct.
C. Chronic volume loss – not a mechanism of HFpEF.
D. Acute valve rupture – causes acute regurgitation, not HFpEF.
ANSWER: B
8. The most common cause of right‑sided heart failure is:
A. Pulmonary embolism – causes cor pulmonale but less commonly.
B. Primary pulmonary hypertension – less common cause.
C. Left‑sided heart failure – correct: pressure transmits backward into the right heart.
D. Right ventricular infarction – less common cause.
ANSWER: C
,9. Which elevated hormone in heart failure acts as a beneficial counter‑regulatory (vasodilatory,
natriuretic) hormone?
A. Aldosterone – sodium‑retaining and maladaptive.
B. Antidiuretic hormone – promotes water retention.
C. Angiotensin II – potent vasoconstrictor.
D. B‑type natriuretic peptide – correct: promotes natriuresis and vasodilation, though insufficient.
ANSWER: D
10. Chronic RAAS activation in heart failure leads to:
A. Natriuresis – opposite effect.
B. Vasodilation – opposite effect.
C. Myocardial fibrosis and adverse remodeling – correct.
D. Bradycardia – sympathetic activation causes tachycardia.
ANSWER: C
11. In the failing heart, the Frank‑Starling relationship shows that:
A. Contractility always rises with preload – true only in normal myocardium.
B. Beyond a point, increased preload fails to increase stroke volume – correct.
C. Afterload is the main driver of the curve – incorrect.
D. Heart rate determines the curve – incorrect.
ANSWER: B
12. Chronic volume overload produces which ventricular geometric change?
A. Concentric thickening only – response to pressure overload.
B. Dilated, spherical ventricle (eccentric remodeling) – correct.
C. Normal geometry – incorrect.
D. Isolated right ventricular thinning – incorrect.
ANSWER: B
13. Ejection fraction is calculated as:
A. SV × HR – that is cardiac output.
B. (EDV − ESV) ÷ EDV – correct.
C. CO ÷ BSA – that is cardiac index.
, D. EDV + ESV – meaningless sum.
ANSWER: B
14. A normal left ventricular ejection fraction is approximately:
A. 20–35% – severe systolic dysfunction.
B. <40% – *defines HFrEF.*
C. 50–70% – *correct.*
D. >90% – hyperdynamic state.
ANSWER: C
15. Which condition classically causes high‑output heart failure?
A. Aortic stenosis – pressure overload, low‑output pattern.
B. Severe chronic anemia – correct: persistent hyperdynamic circulation.
C. Coronary artery disease – ischemic low‑output failure.
D. Systemic hypertension – afterload‑related low‑output failure.
ANSWER: B
16. Which chemotherapy agent causes dose‑dependent, usually irreversible cardiomyopathy?
A. Trastuzumab – type II injury, often reversible.
B. Doxorubicin (anthracycline) – correct: type I myocyte necrosis, cumulative dose‑related.
C. Cisplatin – mainly vascular and renal toxicity.
D. Vincristine – mainly neuropathy.
ANSWER: B
17. The most common valvular lesion causing heart failure in the elderly is:
A. Mitral valve prolapse – less common cause.
B. Pulmonic stenosis – rare.
C. Aortic stenosis – correct: pressure overload and diastolic/systolic strain.
D. Tricuspid regurgitation – usually secondary to other disease.
ANSWER: C
18. Which heart failure risk factor is non‑modifiable?
A. Sodium intake – modifiable.
B. Physical inactivity – modifiable.
Edition
Complete practice exam with verified ANSWERS
Section 1 – Etiology, Anatomy & Pathophysiology (Q1–20)
1. Which of the following is the most common cause of heart failure in developed countries?
A. Hypertension – important contributor, but second to ischemic disease.
B. Coronary artery disease – correct: ischemic myocardial injury impairs cardiac function.
C. Valvular heart disease – less common etiology in developed nations.
D. Viral myocarditis – uncommon, sporadic cause.
ANSWER: B
2. A patient presents with dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Which
type of heart failure is most likely?
A. Right‑sided heart failure – produces systemic congestion (edema, JVD), not pulmonary symptoms.
B. High‑output heart failure – rare hyperdynamic state (anemia, thyrotoxicosis).
C. Left‑sided heart failure – correct: pulmonary venous congestion causes these classic symptoms.
D. Constrictive pericarditis – presents with predominant right‑sided signs.
ANSWER: C
3. Which biomarker is most useful for diagnosing and prognosticating heart failure?
A. Troponin I – marks myocyte injury, not volume overload.
B. CK‑MB – low specificity for heart failure.
C. C‑reactive protein – inflammatory marker, nonspecific.
D. B‑type natriuretic peptide (BNP) – correct: released with ventricular wall stress; correlates with
severity.
ANSWER: D
4. What is the mechanism of action of ACE inhibitors in heart failure?
,A. Increase heart rate – incorrect; heart rate is unchanged or slightly reduced.
B. Block beta‑adrenergic receptors – that is the beta‑blocker mechanism.
C. Decrease afterload and preload by inhibiting angiotensin II formation – correct.
D. Promote sodium retention – opposite of the desired effect.
ANSWER: C
5. The primary function of the left ventricle is to:
A. Receive systemic venous return – function of the right atrium.
B. Pump oxygenated blood to the systemic circulation – correct.
C. Pump blood to the lungs – function of the right ventricle.
D. Drain coronary venous blood – function of the coronary sinus.
ANSWER: B
6. HFrEF is defined by:
A. EF ≥50% with stiff ventricle – describes HFpEF.
B. EF ≤40% with impaired systolic contraction – correct.
C. Normal EF with high output – high‑output failure.
D. Pericardial thickening – constrictive pericarditis.
ANSWER: B
7. The primary defect in HFpEF is:
A. Reduced contractility – feature of HFrEF.
B. Impaired relaxation and diastolic filling – correct.
C. Chronic volume loss – not a mechanism of HFpEF.
D. Acute valve rupture – causes acute regurgitation, not HFpEF.
ANSWER: B
8. The most common cause of right‑sided heart failure is:
A. Pulmonary embolism – causes cor pulmonale but less commonly.
B. Primary pulmonary hypertension – less common cause.
C. Left‑sided heart failure – correct: pressure transmits backward into the right heart.
D. Right ventricular infarction – less common cause.
ANSWER: C
,9. Which elevated hormone in heart failure acts as a beneficial counter‑regulatory (vasodilatory,
natriuretic) hormone?
A. Aldosterone – sodium‑retaining and maladaptive.
B. Antidiuretic hormone – promotes water retention.
C. Angiotensin II – potent vasoconstrictor.
D. B‑type natriuretic peptide – correct: promotes natriuresis and vasodilation, though insufficient.
ANSWER: D
10. Chronic RAAS activation in heart failure leads to:
A. Natriuresis – opposite effect.
B. Vasodilation – opposite effect.
C. Myocardial fibrosis and adverse remodeling – correct.
D. Bradycardia – sympathetic activation causes tachycardia.
ANSWER: C
11. In the failing heart, the Frank‑Starling relationship shows that:
A. Contractility always rises with preload – true only in normal myocardium.
B. Beyond a point, increased preload fails to increase stroke volume – correct.
C. Afterload is the main driver of the curve – incorrect.
D. Heart rate determines the curve – incorrect.
ANSWER: B
12. Chronic volume overload produces which ventricular geometric change?
A. Concentric thickening only – response to pressure overload.
B. Dilated, spherical ventricle (eccentric remodeling) – correct.
C. Normal geometry – incorrect.
D. Isolated right ventricular thinning – incorrect.
ANSWER: B
13. Ejection fraction is calculated as:
A. SV × HR – that is cardiac output.
B. (EDV − ESV) ÷ EDV – correct.
C. CO ÷ BSA – that is cardiac index.
, D. EDV + ESV – meaningless sum.
ANSWER: B
14. A normal left ventricular ejection fraction is approximately:
A. 20–35% – severe systolic dysfunction.
B. <40% – *defines HFrEF.*
C. 50–70% – *correct.*
D. >90% – hyperdynamic state.
ANSWER: C
15. Which condition classically causes high‑output heart failure?
A. Aortic stenosis – pressure overload, low‑output pattern.
B. Severe chronic anemia – correct: persistent hyperdynamic circulation.
C. Coronary artery disease – ischemic low‑output failure.
D. Systemic hypertension – afterload‑related low‑output failure.
ANSWER: B
16. Which chemotherapy agent causes dose‑dependent, usually irreversible cardiomyopathy?
A. Trastuzumab – type II injury, often reversible.
B. Doxorubicin (anthracycline) – correct: type I myocyte necrosis, cumulative dose‑related.
C. Cisplatin – mainly vascular and renal toxicity.
D. Vincristine – mainly neuropathy.
ANSWER: B
17. The most common valvular lesion causing heart failure in the elderly is:
A. Mitral valve prolapse – less common cause.
B. Pulmonic stenosis – rare.
C. Aortic stenosis – correct: pressure overload and diastolic/systolic strain.
D. Tricuspid regurgitation – usually secondary to other disease.
ANSWER: C
18. Which heart failure risk factor is non‑modifiable?
A. Sodium intake – modifiable.
B. Physical inactivity – modifiable.
