CARDIOLOGY FISDAP PRACTICE QUESTION AND ANSWER 2026/2027
EMS / PARAMEDIC EDUCATION | FISDAP CARDIOLOGY EXAM PREPARATION
CARDIOLOGY FISDAP PRACTICE
QUESTION AND ANSWER 2026/2027
A comprehensive 100-question multiple-choice practice examination aligned with the FISDAP Cardiology Exam
Blueprint, the National Registry of EMT (NREMT) Paramedic Cardiology Standards, and the AHA Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Every question includes a marked
correct answer and a detailed rationale referencing exam standards and evidence-based emergency care.
Cognitive Mix
100 Questions Format Answer Key
20% Recall / 45% Application / 35%
7 Sections Multiple Choice (A-D) Inline with Rationales
Analysis
Section 1: Cardiac Anatomy & Electrophysiology
Q1: A paramedic is explaining cardiac anatomy to a newly hired EMT partner. Which heart chamber receives
oxygenated blood returning from the lungs via the pulmonary veins and then delivers it through the mitral valve?
A. Right atrium
B. Right ventricle
C. Left atrium [CORRECT]
D. Left ventricle
Correct Answer: C
Rationale: The left atrium receives oxygenated blood from the four pulmonary veins and passes it through the mitral
(bicuspid) valve into the left ventricle. The right atrium receives deoxygenated blood from the vena cavae, and the
right ventricle pumps blood to the lungs through the pulmonic valve. This is core FISDAP cardiology anatomy content
that appears frequently on the entrance-level items.
Q2: During your paramedic education lab, you are asked to identify the coronary artery that, in approximately
80-85 percent of patients, supplies the inferior wall of the left ventricle and the sinoatrial (SA) node. Which vessel
is this?
A. Left anterior descending (LAD) artery
B. Right coronary artery (RCA) [CORRECT]
C. Left circumflex artery
D. Left main coronary artery
Correct Answer: B
Rationale: In most patients the right coronary artery gives off the posterior descending artery and supplies the inferior
wall, the SA node in about 60 percent of people, and the AV node in about 80-90 percent. The LAD supplies the
anterior wall and septum, and the circumflex supplies the lateral wall. Knowing coronary territories is essential for
correlating 12-lead ECG findings with the culprit artery, a skill FISDAP and the NREMT consistently test.
EMS / Paramedic Cardiology Examination Preparation 1
,CARDIOLOGY FISDAP PRACTICE QUESTION AND ANSWER 2026/2027
Q3: Which structure is considered the primary pacemaker of the heart, possessing the highest intrinsic rate of
automaticity at 60-100 discharges per minute?
A. Atrioventricular (AV) node
B. Bundle of His
C. Sinoatrial (SA) node [CORRECT]
D. Purkinje fiber system
Correct Answer: C
Rationale: The SA node is the heart's dominant pacemaker with an intrinsic firing rate of 60-100 per minute. The AV
junction fires at 40-60 per minute, and the Purkinje system (ventricular escape) fires at only 20-40 per minute.
Because pacemaker hierarchy follows the fastest intrinsic rate, suppression of the SA node allows slower escape
pacemakers to emerge, which explains junctional and idioventricular escape rhythms tested on FISDAP.
Q4: Trace the normal sequence of electrical conduction through the heart, in order, from initiation to ventricular
contraction.
A. AV node, SA node, bundle of His, Purkinje fibers, bundle branches
B. SA node, atrial pathways, AV node, bundle of His, bundle branches, Purkinje fibers [CORRECT]
C. SA node, bundle of His, AV node, Purkinje fibers, bundle branches
D. AV node, bundle branches, SA node, bundle of His, Purkinje fibers
Correct Answer: B
Rationale: The impulse originates in the SA node, travels across the atria via internodal and intra-atrial pathways,
pauses briefly in the AV node, continues through the bundle of His, divides into the right and left bundle branches, and
terminates in the Purkinje fibers that trigger ventricular depolarization. The remaining choices scramble this fixed
physiologic sequence. This pathway corresponds directly to the ECG waveforms (P wave, PR segment, QRS complex)
assessed throughout the FISDAP cardiology section.
Q5: What is the physiologic purpose of the normal delay in electrical conduction at the atrioventricular (AV)
node?
A. It allows the atria to contract and complete ventricular filling before ventricular depolarization
[CORRECT]
B. It amplifies the electrical signal to reach the Purkinje fibers
C. It prevents retrograde conduction from the bundle of His
D. It generates the force needed for ventricular ejection
Correct Answer: A
Rationale: The AV node deliberately slows impulse conduction by about 0.1 second, which permits atrial systole (the
atrial kick) to finish filling the ventricles before the QRS complex triggers ventricular contraction. This delay
corresponds to the PR segment on the ECG. The AV node also serves as a backup pacemaker and a protective gate
against rapid atrial rates such as atrial fibrillation and flutter, a concept repeatedly tested in FISDAP rhythm
interpretation items.
EMS / Paramedic Cardiology Examination Preparation 2
,CARDIOLOGY FISDAP PRACTICE QUESTION AND ANSWER 2026/2027
Q6: On the ECG, the P wave directly represents which cardiac electrical event?
A. Ventricular depolarization
B. Atrial depolarization [CORRECT]
C. Ventricular repolarization
D. Atrial repolarization
Correct Answer: B
Rationale: The P wave represents atrial depolarization, the electrical activation that precedes atrial contraction.
Ventricular depolarization produces the QRS complex, ventricular repolarization produces the T wave, and atrial
repolarization is buried within the QRS complex and is not seen as a separate deflection. FISDAP expects candidates
to pair every ECG waveform with its electrical and mechanical counterpart, because rhythm naming depends on
identifying which waveforms are present or absent.
Q7: A patient's monitor shows a QRS duration of 0.16 seconds. What does a widened QRS complex (greater than
0.12 seconds) indicate about ventricular depolarization?
A. Conduction is proceeding normally through the Purkinje fibers
B. Ventricular depolarization is prolonged, often because the impulse originated in the ventricles or travels
through abnormal (bundle branch) pathways [CORRECT]
C. The atria are depolarizing abnormally slowly
D. The ST segment is elevated above the baseline
Correct Answer: B
Rationale: A QRS wider than 0.12 seconds means the ventricles depolarize slowly and abnormally, classically because
the impulse arises below the bundle of His (ventricular rhythm) or is delayed in a bundle branch. Rapid Purkinje
conduction produces the narrow QRS of supraventricular rhythms. Distinguishing narrow-complex from
wide-complex rhythms drives nearly every ACLS treatment decision, from adenosine use to amiodarone and pacing,
which is why FISDAP weights this concept heavily.
Q8: A paramedic student calculates a patient's cardiac performance values. Using the equation CO = HR x SV,
what is the cardiac output of a patient with a heart rate of 70 beats per minute and a stroke volume of 70 mL?
A. 4,900 mL/min (approximately 5 L/min) [CORRECT]
B. 700 mL/min
C. 140 mL/min
D. 10 L/min
Correct Answer: A
Rationale: Cardiac output equals heart rate multiplied by stroke volume: 70 x 70 = 4,900 mL/min, or about 5 L/min,
which is the normal resting adult value. The other answers reflect common arithmetic or conceptual errors, such as
adding or dividing the variables. Cardiac output, preload, afterload, and contractility form the hemodynamic
foundation tested in both the FISDAP cardiology and shock sections, and they explain why tachycardia and volume
status so strongly affect the perfusing patient.
EMS / Paramedic Cardiology Examination Preparation 3
, CARDIOLOGY FISDAP PRACTICE QUESTION AND ANSWER 2026/2027
Q9: Following a large volume loss from a GI bleed, a patient's heart is stretched by increased venous return before
the bleed worsens. According to the Frank-Starling law of the heart, what happens to myocardial contraction when
myocardial fiber stretch (preload) is increased within physiologic limits?
A. Contractile force decreases proportionally
B. Contractile force increases, improving stroke volume [CORRECT]
C. Heart rate decreases reflexively
D. Coronary artery blood flow stops during systole
Correct Answer: B
Rationale: The Frank-Starling mechanism states that increased preload stretches myocardial fibers, optimizing
actin-myosin overlap and producing a stronger contraction and larger stroke volume. Beyond physiologic limits the
relationship fails and contractility declines, which is the mechanism of volume-overload heart failure. Understanding
preload helps the paramedic predict the effects of fluid administration, venodilators, and diuretics, a
pharmacologic-hemodynamic link emphasized throughout FISDAP.
Q10: Which parameter best describes afterload, and which pathologic condition increases it?
A. Volume in the ventricle at end-diastole; hypovolemia
B. Resistance the ventricle must overcome to eject blood; systemic hypertension [CORRECT]
C. Pressure in the atria during systole; mitral stenosis
D. Force of atrial contraction; atrial fibrillation
Correct Answer: B
Rationale: Afterload is the systemic vascular resistance against which the left ventricle must pump; hypertension and
aortic stenosis increase it, raising myocardial oxygen demand and reducing stroke volume in a failing heart.
End-diastolic volume defines preload, not afterload. Reducing afterload with agents such as nitroglycerin decreases
myocardial workload, which is central to prehospital management of both acute coronary syndromes and flash
pulmonary edema on FISDAP examinations.
Q11: During phase 0 of the ventricular myocyte action potential, which ionic event produces rapid
depolarization?
A. Rapid influx of sodium ions through fast sodium channels [CORRECT]
B. Slow influx of calcium through L-type channels
C. Efflux of potassium ions
D. Chloride influx and membrane hyperpolarization
Correct Answer: A
Rationale: Phase 0 depolarization in working myocardial cells results from rapid sodium influx through fast
voltage-gated sodium channels, producing the steep upslope of the action potential and the QRS complex. Slow
calcium influx dominates phases 0 and 4 in the SA and AV nodes (the basis of calcium channel blocker effects), and
potassium efflux drives repolarization in phases 1-3. Antiarrhythmic drug classes act on these exact channels, so
FISDAP ties this physiology directly to the Vaughan-Williams classification tested in the pharmacology domain.
EMS / Paramedic Cardiology Examination Preparation 4
EMS / PARAMEDIC EDUCATION | FISDAP CARDIOLOGY EXAM PREPARATION
CARDIOLOGY FISDAP PRACTICE
QUESTION AND ANSWER 2026/2027
A comprehensive 100-question multiple-choice practice examination aligned with the FISDAP Cardiology Exam
Blueprint, the National Registry of EMT (NREMT) Paramedic Cardiology Standards, and the AHA Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Every question includes a marked
correct answer and a detailed rationale referencing exam standards and evidence-based emergency care.
Cognitive Mix
100 Questions Format Answer Key
20% Recall / 45% Application / 35%
7 Sections Multiple Choice (A-D) Inline with Rationales
Analysis
Section 1: Cardiac Anatomy & Electrophysiology
Q1: A paramedic is explaining cardiac anatomy to a newly hired EMT partner. Which heart chamber receives
oxygenated blood returning from the lungs via the pulmonary veins and then delivers it through the mitral valve?
A. Right atrium
B. Right ventricle
C. Left atrium [CORRECT]
D. Left ventricle
Correct Answer: C
Rationale: The left atrium receives oxygenated blood from the four pulmonary veins and passes it through the mitral
(bicuspid) valve into the left ventricle. The right atrium receives deoxygenated blood from the vena cavae, and the
right ventricle pumps blood to the lungs through the pulmonic valve. This is core FISDAP cardiology anatomy content
that appears frequently on the entrance-level items.
Q2: During your paramedic education lab, you are asked to identify the coronary artery that, in approximately
80-85 percent of patients, supplies the inferior wall of the left ventricle and the sinoatrial (SA) node. Which vessel
is this?
A. Left anterior descending (LAD) artery
B. Right coronary artery (RCA) [CORRECT]
C. Left circumflex artery
D. Left main coronary artery
Correct Answer: B
Rationale: In most patients the right coronary artery gives off the posterior descending artery and supplies the inferior
wall, the SA node in about 60 percent of people, and the AV node in about 80-90 percent. The LAD supplies the
anterior wall and septum, and the circumflex supplies the lateral wall. Knowing coronary territories is essential for
correlating 12-lead ECG findings with the culprit artery, a skill FISDAP and the NREMT consistently test.
EMS / Paramedic Cardiology Examination Preparation 1
,CARDIOLOGY FISDAP PRACTICE QUESTION AND ANSWER 2026/2027
Q3: Which structure is considered the primary pacemaker of the heart, possessing the highest intrinsic rate of
automaticity at 60-100 discharges per minute?
A. Atrioventricular (AV) node
B. Bundle of His
C. Sinoatrial (SA) node [CORRECT]
D. Purkinje fiber system
Correct Answer: C
Rationale: The SA node is the heart's dominant pacemaker with an intrinsic firing rate of 60-100 per minute. The AV
junction fires at 40-60 per minute, and the Purkinje system (ventricular escape) fires at only 20-40 per minute.
Because pacemaker hierarchy follows the fastest intrinsic rate, suppression of the SA node allows slower escape
pacemakers to emerge, which explains junctional and idioventricular escape rhythms tested on FISDAP.
Q4: Trace the normal sequence of electrical conduction through the heart, in order, from initiation to ventricular
contraction.
A. AV node, SA node, bundle of His, Purkinje fibers, bundle branches
B. SA node, atrial pathways, AV node, bundle of His, bundle branches, Purkinje fibers [CORRECT]
C. SA node, bundle of His, AV node, Purkinje fibers, bundle branches
D. AV node, bundle branches, SA node, bundle of His, Purkinje fibers
Correct Answer: B
Rationale: The impulse originates in the SA node, travels across the atria via internodal and intra-atrial pathways,
pauses briefly in the AV node, continues through the bundle of His, divides into the right and left bundle branches, and
terminates in the Purkinje fibers that trigger ventricular depolarization. The remaining choices scramble this fixed
physiologic sequence. This pathway corresponds directly to the ECG waveforms (P wave, PR segment, QRS complex)
assessed throughout the FISDAP cardiology section.
Q5: What is the physiologic purpose of the normal delay in electrical conduction at the atrioventricular (AV)
node?
A. It allows the atria to contract and complete ventricular filling before ventricular depolarization
[CORRECT]
B. It amplifies the electrical signal to reach the Purkinje fibers
C. It prevents retrograde conduction from the bundle of His
D. It generates the force needed for ventricular ejection
Correct Answer: A
Rationale: The AV node deliberately slows impulse conduction by about 0.1 second, which permits atrial systole (the
atrial kick) to finish filling the ventricles before the QRS complex triggers ventricular contraction. This delay
corresponds to the PR segment on the ECG. The AV node also serves as a backup pacemaker and a protective gate
against rapid atrial rates such as atrial fibrillation and flutter, a concept repeatedly tested in FISDAP rhythm
interpretation items.
EMS / Paramedic Cardiology Examination Preparation 2
,CARDIOLOGY FISDAP PRACTICE QUESTION AND ANSWER 2026/2027
Q6: On the ECG, the P wave directly represents which cardiac electrical event?
A. Ventricular depolarization
B. Atrial depolarization [CORRECT]
C. Ventricular repolarization
D. Atrial repolarization
Correct Answer: B
Rationale: The P wave represents atrial depolarization, the electrical activation that precedes atrial contraction.
Ventricular depolarization produces the QRS complex, ventricular repolarization produces the T wave, and atrial
repolarization is buried within the QRS complex and is not seen as a separate deflection. FISDAP expects candidates
to pair every ECG waveform with its electrical and mechanical counterpart, because rhythm naming depends on
identifying which waveforms are present or absent.
Q7: A patient's monitor shows a QRS duration of 0.16 seconds. What does a widened QRS complex (greater than
0.12 seconds) indicate about ventricular depolarization?
A. Conduction is proceeding normally through the Purkinje fibers
B. Ventricular depolarization is prolonged, often because the impulse originated in the ventricles or travels
through abnormal (bundle branch) pathways [CORRECT]
C. The atria are depolarizing abnormally slowly
D. The ST segment is elevated above the baseline
Correct Answer: B
Rationale: A QRS wider than 0.12 seconds means the ventricles depolarize slowly and abnormally, classically because
the impulse arises below the bundle of His (ventricular rhythm) or is delayed in a bundle branch. Rapid Purkinje
conduction produces the narrow QRS of supraventricular rhythms. Distinguishing narrow-complex from
wide-complex rhythms drives nearly every ACLS treatment decision, from adenosine use to amiodarone and pacing,
which is why FISDAP weights this concept heavily.
Q8: A paramedic student calculates a patient's cardiac performance values. Using the equation CO = HR x SV,
what is the cardiac output of a patient with a heart rate of 70 beats per minute and a stroke volume of 70 mL?
A. 4,900 mL/min (approximately 5 L/min) [CORRECT]
B. 700 mL/min
C. 140 mL/min
D. 10 L/min
Correct Answer: A
Rationale: Cardiac output equals heart rate multiplied by stroke volume: 70 x 70 = 4,900 mL/min, or about 5 L/min,
which is the normal resting adult value. The other answers reflect common arithmetic or conceptual errors, such as
adding or dividing the variables. Cardiac output, preload, afterload, and contractility form the hemodynamic
foundation tested in both the FISDAP cardiology and shock sections, and they explain why tachycardia and volume
status so strongly affect the perfusing patient.
EMS / Paramedic Cardiology Examination Preparation 3
, CARDIOLOGY FISDAP PRACTICE QUESTION AND ANSWER 2026/2027
Q9: Following a large volume loss from a GI bleed, a patient's heart is stretched by increased venous return before
the bleed worsens. According to the Frank-Starling law of the heart, what happens to myocardial contraction when
myocardial fiber stretch (preload) is increased within physiologic limits?
A. Contractile force decreases proportionally
B. Contractile force increases, improving stroke volume [CORRECT]
C. Heart rate decreases reflexively
D. Coronary artery blood flow stops during systole
Correct Answer: B
Rationale: The Frank-Starling mechanism states that increased preload stretches myocardial fibers, optimizing
actin-myosin overlap and producing a stronger contraction and larger stroke volume. Beyond physiologic limits the
relationship fails and contractility declines, which is the mechanism of volume-overload heart failure. Understanding
preload helps the paramedic predict the effects of fluid administration, venodilators, and diuretics, a
pharmacologic-hemodynamic link emphasized throughout FISDAP.
Q10: Which parameter best describes afterload, and which pathologic condition increases it?
A. Volume in the ventricle at end-diastole; hypovolemia
B. Resistance the ventricle must overcome to eject blood; systemic hypertension [CORRECT]
C. Pressure in the atria during systole; mitral stenosis
D. Force of atrial contraction; atrial fibrillation
Correct Answer: B
Rationale: Afterload is the systemic vascular resistance against which the left ventricle must pump; hypertension and
aortic stenosis increase it, raising myocardial oxygen demand and reducing stroke volume in a failing heart.
End-diastolic volume defines preload, not afterload. Reducing afterload with agents such as nitroglycerin decreases
myocardial workload, which is central to prehospital management of both acute coronary syndromes and flash
pulmonary edema on FISDAP examinations.
Q11: During phase 0 of the ventricular myocyte action potential, which ionic event produces rapid
depolarization?
A. Rapid influx of sodium ions through fast sodium channels [CORRECT]
B. Slow influx of calcium through L-type channels
C. Efflux of potassium ions
D. Chloride influx and membrane hyperpolarization
Correct Answer: A
Rationale: Phase 0 depolarization in working myocardial cells results from rapid sodium influx through fast
voltage-gated sodium channels, producing the steep upslope of the action potential and the QRS complex. Slow
calcium influx dominates phases 0 and 4 in the SA and AV nodes (the basis of calcium channel blocker effects), and
potassium efflux drives repolarization in phases 1-3. Antiarrhythmic drug classes act on these exact channels, so
FISDAP ties this physiology directly to the Vaughan-Williams classification tested in the pharmacology domain.
EMS / Paramedic Cardiology Examination Preparation 4
