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ABFM Heart Disease Study Guide 2025/ 2026 –
Comprehensive Review & Practice for Board
Certification||Latest Exam!!!
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
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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
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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
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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
ABFM Heart Disease Study Guide 2025/ 2026 –
Comprehensive Review & Practice for Board
Certification||Latest Exam!!!
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
,2|Page
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
,3|Page
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
, 4|Page
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
