ABFM Heart Disease Exam Study Guide 2026
Questions with Correct Detailed Answers ||
100% Guaranteed Pass
<Recent Version>
1. An 82-year-old female presents with increasing dyspnea. Her husband is
worried because she occasionally stops breathing when she is asleep. You
have been treating the patient for heart failure for the past 2 years with ACE
inhibitors, β-blockers, diuretics, and low-dose spironolactone (Aldactone).
The nurse who measures the patient's blood pressure notes that the systolic
sounds are heard first at a pressure of 135 mm Hg and a pulse rate of 40
beats/min. At 120 mm Hg the nurse hears Korotkoff sounds at a regular rate
of 80/min.Which one of the following is true regarding this patient?
The examination findings are normal for patients in this age group
The patient's breathing pattern is normal for patients in this age group
Both the breathing and blood pressure findings may improve with more
intensive treatment
Medications should be reduced in this patient because her blood pressure is
unstable - ANSWER ✔ C
This patient has pulsus alternans, which is common in patients with
decompensated heart failure and advanced myocardial disease. Effective
treatment can make this finding disappear. Cheyne-Stokes breathing is also
common in patients with decompensated heart failure. If the heart failure is
treated, the breathing abnormality can disappear. The patient has
symptomatic heart failure, which classifies her heart failure as stage C at
least, according to the American College of Cardiology/American Heart
Association heart failure guidelines.
2. A 69-year-old female presents to the emergency department with a 1-hour
episode of severe substernal chest pain that has now resolved. Her past
medical history is notable for current tobacco abuse, hypertension, and
depression. Her current medications include lisinopril/hydrochlorothiazide
, (Zestoretic), 10/12.5 mg daily; citalopram (Celexa), 20 mg daily; and
aspirin, 81 mg daily. On examination she has a blood pressure of 150/92 mm
Hg and a pulse rate of 92 beats/min. An EKG reveals a sinus rhythm with
deep and symmetrical T-wave inversions in the inferior leads.You decide to
admit the patient to the hospital. Which one of the following should be
administered on admission?
Alteplase (Activase) intravenously
Aspirin, 81 mg, and nitroglycerin via intravenous drip
Enoxaparin (Lovenox), 1 mg/kg subcutaneously, and nitroglycerin, 0.4 mg
sublingually
Ticagrelor (Brilinta), 60 mg orally, and enoxaparin, 1 mg/kg subcutaneou -
ANSWER ✔ E
The management of unstable angina or non-ST-elevation myocardial
infarction (NSTEMI) is similar to the management of ST-elevation
myocardial infarction except that fibrinolytic therapy has no role in unstable
angina or NSTEMI (SOR A). Studies indicate that fibrinolytic therapy in
these patients has no benefit in terms of mortality or myocardial infarction
(MI), and may even increase the risk for intracranial hemorrhage and both
fatal and nonfatal MI.Unless there is a contraindication, all patients with
acute coronary syndrome should begin dual antiplatelet therapy with aspirin,
starting with a loading dose of 325 mg followed by a maintenance dosage of
81 mg daily, and a P2Y12 inhibitor (either clopidogrel, prasugrel, or
ticagrelor), as well as anticoagulation therapy with either low molecular
weight heparin (SOR A), fondaparinux in combination with a factor IIa
inhibitor (SOR B), unfractionated heparin (SOR B), or bivalirudin in
patients managed with an early invasive strategy (SOR B). β-Blockers have
been shown to reduce myocardial ischemia, reinfarction, and the frequency
of complex ventricular dysrhythmias, and they increase long-term survival.
Provided there are no contraindications, American Heart Association
guidelines recommend that oral β-blocker therapy be initiated within the first
24 hours in patients with acute coronary syndrome (SOR A).
3. A 65-year-old African-American male presents with a 2-month history of
exertional dyspnea and ankle swelling. His past medical history is notable
for hypertension and angioedema related to a peanut allergy.On examination
his blood pressure is 155/98 mm Hg. His jugular veins are mildly distended
and bibasilar rales are noted. The cardiac examination reveals a regular
rhythm with a soft S3 and no murmur. Examination of the lower extremities
, reveals 1+ pitting ankle edema. Echocardiography shows an estimated left
ventricular ejection fraction of 40%.Which one of the following medications
should be AVOIDED in this patient?
Amlodipine (Norvasc)
Carvedilol (Coreg)
Enalapril (Vasotec)
Furosemide (Lasix)
Hydralazine - ANSWER ✔ C
Angioedema occurs in less than 1% of patients taking an ACE inhibitor but
is more common in African-Americans. The American Heart Association
recommends that ACE inhibitors not be initiated in any patient with a
history of angioedema (SOR C). Calcium channel blockers, particularly
those with negative inotropic effects such as verapamil and diltiazem, can
cause a worsening of heart failure and should also be avoided (SOR
C).Although angiotensin receptor blockers (ARBs) would be regarded as
safe in this patient and may be considered as alternative therapy for patients
who develop angioedema while taking an ACE inhibitor, angioedema can
also occur in patients taking ARBs and extreme caution is advisable when
substituting an ARB in a patient with a history of ACE inhibitor-associated
angioedema (SOR C). There are no contraindications to the use of a diuretic
or a β-blocker in this patient.
4. A 74-year-old female presents with a 2-month history of increased dyspnea
on exertion. She was a long-time cigarette smoker but quit 20 years ago. She
has COPD treated with inhaled ipratropium (Atrovent), a combination
inhaled corticosteroid, and a long-acting β-agonist. She can walk up one
flight of stairs in her home but for the past 2 months she has had to stop and
rest before reaching the top due to increased dyspnea. She also has severe
osteoarthritis of the left hip treated with acetaminophen, 1000 mg three
times daily, and tramadol (Ultram), 50 mg twice daily. A resting EKG in the
office is normal.Which one of the following would be the most appropriate
initial study to evaluate this patient for ischemic heart disease?
A treadmill exercise test
An adenosine technetium 99m test
A dipyridamole thallium test
Treadmill echocardiography
, Dobutamine echocardiography - ANSWER ✔ E
This patient's severe degenerative joint disease would likely limit her ability
to exercise sufficiently to achieve 85% of her expected heart rate, which is
required for an adequate treadmill exercise test, unless the patient is on β-
blocker therapy, which would allow 65% of the predicted heart rate to be
considered adequate. Dipyridamole and adenosine are contraindicated for
patients with severe asthma, COPD, hypotension, bradycardia, or heart
block. A resting EKG and resting echocardiography might be appropriate,
but would not rule out ischemic heart disease. Dobutamine provides a
pharmacologic means to stress the heart in patients who cannot exercise.
These agents enhance myocardial contractile performance and wall motion,
thus making poorly functioning areas assessable by echocardiography. In
patients unable to exercise to the target heart rate, pharmacologic agents are
needed to complete stress testing.
5. A 59-year-old male sees you for a follow-up office visit after having a drug-
eluting stent placed 6 weeks ago following a non-ST-elevation myocardial
infarction. He also has a 2-year history of type 2 diabetes. He was
discharged on the following medications:Aspirin, 81 mg dailyClopidogrel
(Plavix), 75 mg dailyAtorvastatin (Lipitor), 40 mg dailyMetoprolol tartrate
(Lopressor), 25 mg twice dailyRamipril (Altace), 10 mg dailyMetformin
(Glucophage), 500 mg twice dailyThe patient has been asymptomatic since
being discharged from the hospital. On examination he has a blood pressure
of 142/86 mm Hg and a heart rate of 52 beats/min. The remainder of the
examination is unremarkable. A lipid profile reveals an LDL-cholesterol
level of 65 mg/dL, an HDL-cholesterol level of 30 mg/dL, and a serum
triglyceride level of 260 mg/dL. His hemoglobin A1c is 7.2%.Which one of
the following would be most appropriate at this time?
Increas - ANSWER ✔ B
6. The long-term management of patients with non-ST-elevation myocardial
infarction involves measures to prevent recurrent cardiac events, as well as
aggressive reduction of cardiovascular risk factors. The recommended
pharmacotherapy to prevent death and myocardial infarction includes the
following:
aspirin, 81-325 mg daily, indefinitely
Questions with Correct Detailed Answers ||
100% Guaranteed Pass
<Recent Version>
1. An 82-year-old female presents with increasing dyspnea. Her husband is
worried because she occasionally stops breathing when she is asleep. You
have been treating the patient for heart failure for the past 2 years with ACE
inhibitors, β-blockers, diuretics, and low-dose spironolactone (Aldactone).
The nurse who measures the patient's blood pressure notes that the systolic
sounds are heard first at a pressure of 135 mm Hg and a pulse rate of 40
beats/min. At 120 mm Hg the nurse hears Korotkoff sounds at a regular rate
of 80/min.Which one of the following is true regarding this patient?
The examination findings are normal for patients in this age group
The patient's breathing pattern is normal for patients in this age group
Both the breathing and blood pressure findings may improve with more
intensive treatment
Medications should be reduced in this patient because her blood pressure is
unstable - ANSWER ✔ C
This patient has pulsus alternans, which is common in patients with
decompensated heart failure and advanced myocardial disease. Effective
treatment can make this finding disappear. Cheyne-Stokes breathing is also
common in patients with decompensated heart failure. If the heart failure is
treated, the breathing abnormality can disappear. The patient has
symptomatic heart failure, which classifies her heart failure as stage C at
least, according to the American College of Cardiology/American Heart
Association heart failure guidelines.
2. A 69-year-old female presents to the emergency department with a 1-hour
episode of severe substernal chest pain that has now resolved. Her past
medical history is notable for current tobacco abuse, hypertension, and
depression. Her current medications include lisinopril/hydrochlorothiazide
, (Zestoretic), 10/12.5 mg daily; citalopram (Celexa), 20 mg daily; and
aspirin, 81 mg daily. On examination she has a blood pressure of 150/92 mm
Hg and a pulse rate of 92 beats/min. An EKG reveals a sinus rhythm with
deep and symmetrical T-wave inversions in the inferior leads.You decide to
admit the patient to the hospital. Which one of the following should be
administered on admission?
Alteplase (Activase) intravenously
Aspirin, 81 mg, and nitroglycerin via intravenous drip
Enoxaparin (Lovenox), 1 mg/kg subcutaneously, and nitroglycerin, 0.4 mg
sublingually
Ticagrelor (Brilinta), 60 mg orally, and enoxaparin, 1 mg/kg subcutaneou -
ANSWER ✔ E
The management of unstable angina or non-ST-elevation myocardial
infarction (NSTEMI) is similar to the management of ST-elevation
myocardial infarction except that fibrinolytic therapy has no role in unstable
angina or NSTEMI (SOR A). Studies indicate that fibrinolytic therapy in
these patients has no benefit in terms of mortality or myocardial infarction
(MI), and may even increase the risk for intracranial hemorrhage and both
fatal and nonfatal MI.Unless there is a contraindication, all patients with
acute coronary syndrome should begin dual antiplatelet therapy with aspirin,
starting with a loading dose of 325 mg followed by a maintenance dosage of
81 mg daily, and a P2Y12 inhibitor (either clopidogrel, prasugrel, or
ticagrelor), as well as anticoagulation therapy with either low molecular
weight heparin (SOR A), fondaparinux in combination with a factor IIa
inhibitor (SOR B), unfractionated heparin (SOR B), or bivalirudin in
patients managed with an early invasive strategy (SOR B). β-Blockers have
been shown to reduce myocardial ischemia, reinfarction, and the frequency
of complex ventricular dysrhythmias, and they increase long-term survival.
Provided there are no contraindications, American Heart Association
guidelines recommend that oral β-blocker therapy be initiated within the first
24 hours in patients with acute coronary syndrome (SOR A).
3. A 65-year-old African-American male presents with a 2-month history of
exertional dyspnea and ankle swelling. His past medical history is notable
for hypertension and angioedema related to a peanut allergy.On examination
his blood pressure is 155/98 mm Hg. His jugular veins are mildly distended
and bibasilar rales are noted. The cardiac examination reveals a regular
rhythm with a soft S3 and no murmur. Examination of the lower extremities
, reveals 1+ pitting ankle edema. Echocardiography shows an estimated left
ventricular ejection fraction of 40%.Which one of the following medications
should be AVOIDED in this patient?
Amlodipine (Norvasc)
Carvedilol (Coreg)
Enalapril (Vasotec)
Furosemide (Lasix)
Hydralazine - ANSWER ✔ C
Angioedema occurs in less than 1% of patients taking an ACE inhibitor but
is more common in African-Americans. The American Heart Association
recommends that ACE inhibitors not be initiated in any patient with a
history of angioedema (SOR C). Calcium channel blockers, particularly
those with negative inotropic effects such as verapamil and diltiazem, can
cause a worsening of heart failure and should also be avoided (SOR
C).Although angiotensin receptor blockers (ARBs) would be regarded as
safe in this patient and may be considered as alternative therapy for patients
who develop angioedema while taking an ACE inhibitor, angioedema can
also occur in patients taking ARBs and extreme caution is advisable when
substituting an ARB in a patient with a history of ACE inhibitor-associated
angioedema (SOR C). There are no contraindications to the use of a diuretic
or a β-blocker in this patient.
4. A 74-year-old female presents with a 2-month history of increased dyspnea
on exertion. She was a long-time cigarette smoker but quit 20 years ago. She
has COPD treated with inhaled ipratropium (Atrovent), a combination
inhaled corticosteroid, and a long-acting β-agonist. She can walk up one
flight of stairs in her home but for the past 2 months she has had to stop and
rest before reaching the top due to increased dyspnea. She also has severe
osteoarthritis of the left hip treated with acetaminophen, 1000 mg three
times daily, and tramadol (Ultram), 50 mg twice daily. A resting EKG in the
office is normal.Which one of the following would be the most appropriate
initial study to evaluate this patient for ischemic heart disease?
A treadmill exercise test
An adenosine technetium 99m test
A dipyridamole thallium test
Treadmill echocardiography
, Dobutamine echocardiography - ANSWER ✔ E
This patient's severe degenerative joint disease would likely limit her ability
to exercise sufficiently to achieve 85% of her expected heart rate, which is
required for an adequate treadmill exercise test, unless the patient is on β-
blocker therapy, which would allow 65% of the predicted heart rate to be
considered adequate. Dipyridamole and adenosine are contraindicated for
patients with severe asthma, COPD, hypotension, bradycardia, or heart
block. A resting EKG and resting echocardiography might be appropriate,
but would not rule out ischemic heart disease. Dobutamine provides a
pharmacologic means to stress the heart in patients who cannot exercise.
These agents enhance myocardial contractile performance and wall motion,
thus making poorly functioning areas assessable by echocardiography. In
patients unable to exercise to the target heart rate, pharmacologic agents are
needed to complete stress testing.
5. A 59-year-old male sees you for a follow-up office visit after having a drug-
eluting stent placed 6 weeks ago following a non-ST-elevation myocardial
infarction. He also has a 2-year history of type 2 diabetes. He was
discharged on the following medications:Aspirin, 81 mg dailyClopidogrel
(Plavix), 75 mg dailyAtorvastatin (Lipitor), 40 mg dailyMetoprolol tartrate
(Lopressor), 25 mg twice dailyRamipril (Altace), 10 mg dailyMetformin
(Glucophage), 500 mg twice dailyThe patient has been asymptomatic since
being discharged from the hospital. On examination he has a blood pressure
of 142/86 mm Hg and a heart rate of 52 beats/min. The remainder of the
examination is unremarkable. A lipid profile reveals an LDL-cholesterol
level of 65 mg/dL, an HDL-cholesterol level of 30 mg/dL, and a serum
triglyceride level of 260 mg/dL. His hemoglobin A1c is 7.2%.Which one of
the following would be most appropriate at this time?
Increas - ANSWER ✔ B
6. The long-term management of patients with non-ST-elevation myocardial
infarction involves measures to prevent recurrent cardiac events, as well as
aggressive reduction of cardiovascular risk factors. The recommended
pharmacotherapy to prevent death and myocardial infarction includes the
following:
aspirin, 81-325 mg daily, indefinitely
