Heart Failure Certification (HF-C)
Practice Exam Questions & Verified
Answers with Rationales (2026 Q&A)
SECTION 1: HEART FAILURE CLASSIFICATION &
STAGING
Question 1
A 47-year-old Black woman presents for follow-up following
hospitalization for an acute inferior myocardial infarction 6 weeks
ago. Her left ventricular ejection fraction (LVEF) during hospitalization
was 42%. She currently has no symptoms of heart failure. Her
medications include aspirin, ticagrelor, rosuvastatin, metoprolol
succinate, lisinopril, and metformin. Her current echocardiogram
reveals LVEF 45%. Which of the following best describes this patient's
stage of heart failure?
A. Stage A HF
B. Stage B HF
C. Stage C HF
D. Stage D HF
Correct Answer: B
Rationale: This patient has structural heart disease (SHD) with LVEF
<50% but no current or previous symptoms of HF, placing her at Stage
B (pre-HF). Stage A describes patients at risk for HF without
,symptoms, SHD, or biomarkers of injury. Stage C requires current or
previous HF symptoms, and Stage D describes marked symptoms
interfering with daily life despite optimal therapy.
Question 2
According to the NYHA functional classification, a patient with heart
failure who has marked limitation of physical activity and is
comfortable only at rest would be classified as:
A. NYHA Class I
B. NYHA Class II
C. NYHA Class III
D. NYHA Class IV
Correct Answer: D
Rationale: NYHA Class IV describes patients with symptoms of HF at
rest or with any physical activity. Class I has no limitation, Class II has
slight limitation, and Class III has marked limitation but comfortable at
rest. The NYHA classification is based on the patient's symptoms and
functional limitation, not ejection fraction or imaging findings.
Question 3
Which of the following best describes heart failure with preserved
ejection fraction (HFpEF)?
A. Impaired ventricular contraction and low EF
B. Impaired ventricular relaxation and stiffening with normal EF
C. Valvular regurgitation leading to volume overload
D. Arrhythmogenic cardiomyopathy
, Correct Answer: B
Rationale: HFpEF is characterized by diastolic dysfunction—impaired
ventricular relaxation and increased stiffness—while ejection fraction
remains normal (typically ≥50%). This is often associated with
hypertension and left ventricular hypertrophy. In HFpEF, the diastolic
pressure-volume curve is elevated compared to HFrEF.
Question 4
Heart failure with reduced ejection fraction (HFrEF) is primarily due to:
A. Impaired ventricular relaxation
B. Weak heart muscle contraction
C. Valvular thickening
D. Increased blood viscosity
Correct Answer: B
Rationale: HFrEF is characterized by systolic dysfunction—the heart
muscle cannot contract effectively, leading to reduced ejection
fraction (<40%). This is often due to ischemic injury, cardiomyopathy,
or other causes of myocardial damage.
Question 5
Which of the following is the most common cause of heart failure in
developed countries?
A. Hypertension
B. Coronary artery disease
C. Valvular heart disease
D. Viral myocarditis
Practice Exam Questions & Verified
Answers with Rationales (2026 Q&A)
SECTION 1: HEART FAILURE CLASSIFICATION &
STAGING
Question 1
A 47-year-old Black woman presents for follow-up following
hospitalization for an acute inferior myocardial infarction 6 weeks
ago. Her left ventricular ejection fraction (LVEF) during hospitalization
was 42%. She currently has no symptoms of heart failure. Her
medications include aspirin, ticagrelor, rosuvastatin, metoprolol
succinate, lisinopril, and metformin. Her current echocardiogram
reveals LVEF 45%. Which of the following best describes this patient's
stage of heart failure?
A. Stage A HF
B. Stage B HF
C. Stage C HF
D. Stage D HF
Correct Answer: B
Rationale: This patient has structural heart disease (SHD) with LVEF
<50% but no current or previous symptoms of HF, placing her at Stage
B (pre-HF). Stage A describes patients at risk for HF without
,symptoms, SHD, or biomarkers of injury. Stage C requires current or
previous HF symptoms, and Stage D describes marked symptoms
interfering with daily life despite optimal therapy.
Question 2
According to the NYHA functional classification, a patient with heart
failure who has marked limitation of physical activity and is
comfortable only at rest would be classified as:
A. NYHA Class I
B. NYHA Class II
C. NYHA Class III
D. NYHA Class IV
Correct Answer: D
Rationale: NYHA Class IV describes patients with symptoms of HF at
rest or with any physical activity. Class I has no limitation, Class II has
slight limitation, and Class III has marked limitation but comfortable at
rest. The NYHA classification is based on the patient's symptoms and
functional limitation, not ejection fraction or imaging findings.
Question 3
Which of the following best describes heart failure with preserved
ejection fraction (HFpEF)?
A. Impaired ventricular contraction and low EF
B. Impaired ventricular relaxation and stiffening with normal EF
C. Valvular regurgitation leading to volume overload
D. Arrhythmogenic cardiomyopathy
, Correct Answer: B
Rationale: HFpEF is characterized by diastolic dysfunction—impaired
ventricular relaxation and increased stiffness—while ejection fraction
remains normal (typically ≥50%). This is often associated with
hypertension and left ventricular hypertrophy. In HFpEF, the diastolic
pressure-volume curve is elevated compared to HFrEF.
Question 4
Heart failure with reduced ejection fraction (HFrEF) is primarily due to:
A. Impaired ventricular relaxation
B. Weak heart muscle contraction
C. Valvular thickening
D. Increased blood viscosity
Correct Answer: B
Rationale: HFrEF is characterized by systolic dysfunction—the heart
muscle cannot contract effectively, leading to reduced ejection
fraction (<40%). This is often due to ischemic injury, cardiomyopathy,
or other causes of myocardial damage.
Question 5
Which of the following is the most common cause of heart failure in
developed countries?
A. Hypertension
B. Coronary artery disease
C. Valvular heart disease
D. Viral myocarditis
