ABIM CARDIOLOGY BOARDS QUESTIONS & ANSWERS 2026-2027 | COMPREHENSIVE C…
P R O F E S S I O N A L P R A C T I C E M AT E R I A L S
ABIM Cardiology Boards
Questions & Answers 2026-
2027 | Comprehensive
Cardiology Board Review
(Rationales)
Verified Answers Exam Ready With Rationales 216 QUESTIONS
DOCUMENT OVERVIEW
This comprehensive review document provides 216 cardiology board-style questions, each
accompanied by the correct answer and detailed rationales. It is an essential resource for
cardiology board preparation, offering direct study and review of key concepts. This
material is perfectly suited for honing knowledge and ensuring readiness for certification
examinations.
TOPICS
• Cardiac Physiology & Diagnostics • Hemodynamics & Catheterization
• Acute Coronary Syndromes (ACS) • Post-MI Complications & Management
• Lipid Metabolism & Risk Factors • Coronary Artery Disease (CAD) &
Revascularization
• Congenital Heart Disease & Aortic • Infective Endocarditis & Rheumatic
Disease Fever
• Valvular Heart Disease • Arrhythmias & Conduction Disorders
• Cardiac Pharmacology • Cardiomyopathies & Myocarditis
Page 1
, • Heart Failure (HF) • Pericardial & Myocardial Disease
E XA M Q U EST I O N S
Q1 QUESTION 1 OF 216
What is a positive stress test
CORRECT ANSWER
Flat or Down sloping St-segment depression >1 mm occurring 80 msec after j point
RATIONALE
A positive stress test indicates myocardial ischemia. This is characterized by specific
electrocardiographic changes, namely a flat or downsloping ST-segment depression exceeding 1
millimeter, measured 80 milliseconds after the J-point.
Q2 QUESTION 2 OF 216
When to stop a stress test
CORRECT ANSWER
St segment depression > 2 mm, ventricular tachycardia, drop in SBP > 15, chest pain, dyspnea,
lightheadedness
RATIONALE
St segment depression > 2 mm, ventricular tachycardia, drop in SBP > 15, chest pain, dyspnea,
lightheadedness, specific findings indicate that the patient is experiencing significant myocardial
ischemia or hemodynamic compromise, necessitating cessation of the test. These include the
development of more than 2 mm of ST segment depression, which suggests significant
subendocardial ischemia, or the occurrence of ventricular tachycardia, a potentially life-
threatening arrhythmia.
Q3 QUESTION 3 OF 216
Stress test of choice with a LBBB or ventricular pacing?
Page 2
, CORRECT ANSWER
Myocardial perfusion imaging with adenosine,NOT exercising!
RATIONALE
In patients with left bundle branch block (LBBB) or ventricular pacing, exercise stress testing can
induce false positive results due to electrocardiographic abnormalities that mimic ischemia.
Myocardial perfusion imaging (MPI) with a pharmacological stressor like adenosine is the preferred
method because it achieves adequate vasodilation to assess for perfusion defects without relying
on exercise-induced ST-segment changes.
Q4 QUESTION 4 OF 216
Know the algorithm for stress testing
CORRECT ANSWER
See page 5-3,figure 5-1
RATIONALE
The question asks for the algorithm for stress testing. The provided answer directs the learner to a
specific location within the material, page 5-3, to find figure 5-1.
Q5 QUESTION 5 OF 216
When to not use doutamine for stress
CORRECT ANSWER
History of VT, severe HTN, Low BP, poor echo images
RATIONALE
Dobutamine is a beta-1 adrenergic agonist used for dobutamine stress echocardiography.
Contraindications include a history of ventricular tachycardia (VT), which suggests a propensity for
arrhythmias that could be exacerbated by dobutamine.
Q6 QUESTION 6 OF 216
When to not use adenosine for stress
Page 3
, CORRECT ANSWER
Bronchospasm, severe valvular dysfunction, severe carotid stenosis, 2nd degree heart block,
theophylline dependent
RATIONALE
Adenosine is a vasodilator used in pharmacologic stress testing. Contraindications exist to prevent
adverse effects.
Q7 QUESTION 7 OF 216
Pulsus paradoxus
CORRECT ANSWER
decrease in systolic BP of more than 10mmHg with normal inspiration; palpated as weakened
pulse with inspiration along with more heart contractions to pulse beats
RATIONALE
Pulsus paradoxus is defined by a significant drop in systolic blood pressure (more than 10 mmHg)
during normal inspiration. This phenomenon is caused by increased negative intrathoracic
pressure during inspiration, which enhances venous return to the right heart, leading to right
ventricular distension and septal displacement into the left ventricle. left ventricular filling and
stroke volume decrease, resulting in a palpable weakening of the pulse during inspiration and a
discrepancy between heartbeats and palpable pulses.
Q8 QUESTION 8 OF 216
What conditions give you pulsus paradoxus?
CORRECT ANSWER
Constrictive or restrictive pericarditis, asthma, tension pneumothorax
RATIONALE
Pulsus paradoxus is an exaggerated drop in systolic blood pressure during inspiration, exceeding
10 mmHg. This phenomenon occurs when intrathoracic pressure changes during breathing
significantly impede venous return to the heart or reduce left ventricular filling and stroke volume.
Page 4
P R O F E S S I O N A L P R A C T I C E M AT E R I A L S
ABIM Cardiology Boards
Questions & Answers 2026-
2027 | Comprehensive
Cardiology Board Review
(Rationales)
Verified Answers Exam Ready With Rationales 216 QUESTIONS
DOCUMENT OVERVIEW
This comprehensive review document provides 216 cardiology board-style questions, each
accompanied by the correct answer and detailed rationales. It is an essential resource for
cardiology board preparation, offering direct study and review of key concepts. This
material is perfectly suited for honing knowledge and ensuring readiness for certification
examinations.
TOPICS
• Cardiac Physiology & Diagnostics • Hemodynamics & Catheterization
• Acute Coronary Syndromes (ACS) • Post-MI Complications & Management
• Lipid Metabolism & Risk Factors • Coronary Artery Disease (CAD) &
Revascularization
• Congenital Heart Disease & Aortic • Infective Endocarditis & Rheumatic
Disease Fever
• Valvular Heart Disease • Arrhythmias & Conduction Disorders
• Cardiac Pharmacology • Cardiomyopathies & Myocarditis
Page 1
, • Heart Failure (HF) • Pericardial & Myocardial Disease
E XA M Q U EST I O N S
Q1 QUESTION 1 OF 216
What is a positive stress test
CORRECT ANSWER
Flat or Down sloping St-segment depression >1 mm occurring 80 msec after j point
RATIONALE
A positive stress test indicates myocardial ischemia. This is characterized by specific
electrocardiographic changes, namely a flat or downsloping ST-segment depression exceeding 1
millimeter, measured 80 milliseconds after the J-point.
Q2 QUESTION 2 OF 216
When to stop a stress test
CORRECT ANSWER
St segment depression > 2 mm, ventricular tachycardia, drop in SBP > 15, chest pain, dyspnea,
lightheadedness
RATIONALE
St segment depression > 2 mm, ventricular tachycardia, drop in SBP > 15, chest pain, dyspnea,
lightheadedness, specific findings indicate that the patient is experiencing significant myocardial
ischemia or hemodynamic compromise, necessitating cessation of the test. These include the
development of more than 2 mm of ST segment depression, which suggests significant
subendocardial ischemia, or the occurrence of ventricular tachycardia, a potentially life-
threatening arrhythmia.
Q3 QUESTION 3 OF 216
Stress test of choice with a LBBB or ventricular pacing?
Page 2
, CORRECT ANSWER
Myocardial perfusion imaging with adenosine,NOT exercising!
RATIONALE
In patients with left bundle branch block (LBBB) or ventricular pacing, exercise stress testing can
induce false positive results due to electrocardiographic abnormalities that mimic ischemia.
Myocardial perfusion imaging (MPI) with a pharmacological stressor like adenosine is the preferred
method because it achieves adequate vasodilation to assess for perfusion defects without relying
on exercise-induced ST-segment changes.
Q4 QUESTION 4 OF 216
Know the algorithm for stress testing
CORRECT ANSWER
See page 5-3,figure 5-1
RATIONALE
The question asks for the algorithm for stress testing. The provided answer directs the learner to a
specific location within the material, page 5-3, to find figure 5-1.
Q5 QUESTION 5 OF 216
When to not use doutamine for stress
CORRECT ANSWER
History of VT, severe HTN, Low BP, poor echo images
RATIONALE
Dobutamine is a beta-1 adrenergic agonist used for dobutamine stress echocardiography.
Contraindications include a history of ventricular tachycardia (VT), which suggests a propensity for
arrhythmias that could be exacerbated by dobutamine.
Q6 QUESTION 6 OF 216
When to not use adenosine for stress
Page 3
, CORRECT ANSWER
Bronchospasm, severe valvular dysfunction, severe carotid stenosis, 2nd degree heart block,
theophylline dependent
RATIONALE
Adenosine is a vasodilator used in pharmacologic stress testing. Contraindications exist to prevent
adverse effects.
Q7 QUESTION 7 OF 216
Pulsus paradoxus
CORRECT ANSWER
decrease in systolic BP of more than 10mmHg with normal inspiration; palpated as weakened
pulse with inspiration along with more heart contractions to pulse beats
RATIONALE
Pulsus paradoxus is defined by a significant drop in systolic blood pressure (more than 10 mmHg)
during normal inspiration. This phenomenon is caused by increased negative intrathoracic
pressure during inspiration, which enhances venous return to the right heart, leading to right
ventricular distension and septal displacement into the left ventricle. left ventricular filling and
stroke volume decrease, resulting in a palpable weakening of the pulse during inspiration and a
discrepancy between heartbeats and palpable pulses.
Q8 QUESTION 8 OF 216
What conditions give you pulsus paradoxus?
CORRECT ANSWER
Constrictive or restrictive pericarditis, asthma, tension pneumothorax
RATIONALE
Pulsus paradoxus is an exaggerated drop in systolic blood pressure during inspiration, exceeding
10 mmHg. This phenomenon occurs when intrathoracic pressure changes during breathing
significantly impede venous return to the heart or reduce left ventricular filling and stroke volume.
Page 4
