100+ Free ABIM Cardiology Practice Questions

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Question 1

Score: 0/0

A 58-year-old man presents with 2 hours of crushing chest pain. ECG shows 3 mm ST elevation in leads II, III, and aVF with reciprocal ST depression in I and aVL. Which coronary artery is most likely occluded?

Left anterior descending (LAD)

Left circumflex (LCX)

Right coronary artery (RCA)

Left main coronary artery

to track

2026 Statistics

Key Facts: ABIM Cardiology Exam

~$2,985

Exam Fee

ABIM 2026

Up to 240

MCQs (Scored + Pretest)

ABIM blueprint

21.5%

CAD — Largest Category

ABIM CV blueprint

3 years

Fellowship Required

ACGME-accredited

~88-92%

First-Attempt Pass Rate

ABIM published rates

400-600 hrs

Average Study Time

Board candidates

The ABIM Cardiovascular Disease boards are the gateway to one of medicine's most competitive subspecialty pipelines: ~1,000+ new US cardiology fellows match annually, with ~88-92% first-attempt pass rates (ABIM). Board-certified cardiologists earn a substantial premium over general internists, with median invasive/general compensation of ~$500K-$700K+ (MGMA/Medscape 2024-25). The exam covers up to 240 single-best-answer MCQs across 11 blueprint categories — Coronary Artery Disease (21.5%), Heart Failure/Cardiomyopathy (17%), Arrhythmias (15%), and Valvular Disease (15%) dominate.

Sample ABIM Cardiology Practice Questions

Try these sample questions to test your ABIM Cardiology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man presents with 2 hours of crushing chest pain. ECG shows 3 mm ST elevation in leads II, III, and aVF with reciprocal ST depression in I and aVL. Which coronary artery is most likely occluded?

A.Left anterior descending (LAD)

B.Left circumflex (LCX)

C.Right coronary artery (RCA)

D.Left main coronary artery

Explanation: Inferior STEMI (ST elevation in II, III, aVF) is most commonly caused by RCA occlusion (~80-90% of cases). ST elevation greater in III than II and reciprocal depression in aVL strongly favor RCA over LCX. The remaining ~10-20% of inferior STEMIs are due to a dominant LCX. Right-sided leads (V4R) should be obtained to evaluate for RV involvement.

2In a patient with inferior STEMI, which ECG finding best indicates right ventricular (RV) involvement?

A.ST elevation in V1-V2

B.ST elevation >= 1 mm in V4R

C.ST depression in V5-V6

D.Tall R waves in V1

Explanation: ST elevation of at least 1 mm in the right-sided lead V4R has high sensitivity and specificity for RV infarction in the setting of inferior STEMI. RV MI patients are preload-dependent; avoid nitrates and diuretics, give IV fluids, and consider inotropy if shock develops. Right-sided leads should be obtained routinely for inferior STEMI.

3Which ECG pattern represents a STEMI-equivalent 'de Winter' T waves?

A.Tall peaked T waves in precordial leads with upsloping ST depression at the J point

B.Biphasic T waves in V2-V3 with positive-negative morphology

C.Deeply inverted symmetric T waves in V2-V4

D.Diffuse ST elevation with PR depression

Explanation: De Winter T-wave pattern consists of 1-3 mm upsloping ST depression at the J point with tall, symmetric T waves in the precordial leads, often with ST elevation in aVR. It is a STEMI equivalent seen in ~2% of proximal LAD occlusions and warrants emergent cath lab activation. Wellens syndrome (choice B/C) predicts critical LAD stenosis but is not an acute occlusion. Diffuse ST elevation with PR depression is pericarditis.

4A patient presents with chest pain that resolved. ECG shows biphasic T waves in V2-V3. Cardiac enzymes are negative. What is the most appropriate next step?

A.Discharge home with outpatient stress test in 1 week

B.Urgent coronary angiography

C.Exercise stress test the next morning

D.Start aspirin and discharge

Explanation: Wellens syndrome (biphasic or deeply inverted T waves in V2-V3 after anginal chest pain resolves, negative troponin) indicates a critical proximal LAD stenosis. Patients are at high risk of extensive anterior MI within days. Exercise stress testing is contraindicated because it may precipitate MI. Urgent coronary angiography is indicated, even if pain-free and biomarkers are negative.

5Which Sgarbossa criterion provides the MOST specific evidence of acute MI in the presence of LBBB?

A.Concordant ST elevation >= 1 mm in any lead

B.Concordant ST depression >= 1 mm in V1-V3

C.Discordant ST elevation >= 5 mm

D.All three carry equal weight

Explanation: The original Sgarbossa criteria weight concordant ST elevation (same direction as QRS) >= 1 mm with 5 points, concordant ST depression in V1-V3 with 3 points, and discordant ST elevation >= 5 mm with 2 points. A total >= 3 points is highly specific for MI. The Smith modified Sgarbossa replaces the absolute 5 mm cutoff with an ST/S ratio <= -0.25, improving sensitivity.

6A 68-year-old with a paced rhythm presents with chest pain. Which finding most strongly suggests acute MI?

A.Discordant ST elevation of 2 mm

B.QRS duration of 150 ms

C.Concordant ST elevation of 2 mm

D.Deep Q waves in paced leads

Explanation: In ventricular-paced rhythms (similar physiology to LBBB), modified Sgarbossa criteria apply: concordant ST elevation >= 1 mm, concordant ST depression >= 1 mm in V1-V3, or excessively discordant ST elevation (ST/S ratio <= -0.25 per Smith-modified criteria). Concordant ST elevation is the most specific finding. Pacing intrinsically causes discordant repolarization, so a small amount of discordant ST elevation is expected.

7A patient with inferior STEMI has ST depression in V1-V2. What additional finding would support posterior wall involvement?

A.Tall R wave in V1 (R/S ratio > 1)

B.Deep Q waves in V5-V6

C.T wave inversion in aVL

D.First-degree AV block

Explanation: Posterior MI is often missed because standard 12-lead leads do not directly view the posterior wall. V1-V2 sees the posterior wall as a mirror image: ST depression, tall R waves (R/S ratio > 1), and upright T waves in V1-V2 reflect posterior ST elevation, Q waves, and T wave inversion. Obtain posterior leads V7-V9 (ST elevation >= 0.5 mm is diagnostic). This expands treatment to PCI rather than being dismissed as NSTEMI.

8A 32-year-old man with syncope has an ECG showing coved ST elevation >= 2 mm with inverted T wave in V1-V2. Which diagnosis is most consistent?

A.Brugada syndrome type 1

B.Brugada syndrome type 2

C.Early repolarization

D.Athletic heart

Explanation: Brugada type 1 is the only diagnostic pattern: coved ST elevation >= 2 mm with inverted T waves in V1-V2 (the 'shark fin' pattern). Type 2 is a saddleback pattern (ST elevation >= 2 mm with positive/biphasic T waves) and is not diagnostic alone. In symptomatic patients (syncope, aborted SCD) or with family history of SCD, Brugada type 1 is an indication for ICD. Unmasking with sodium channel blocker (ajmaline, procainamide) is done for suspicious type 2/3 patterns.

9A 25-year-old collapses during exercise and is resuscitated. ECG shows a short PR (<120 ms), delta wave, and wide QRS. What is the mechanism of sudden cardiac death in this disorder?

A.Atrial fibrillation with rapid conduction down an accessory pathway causing ventricular fibrillation

B.Complete heart block leading to asystole

C.Torsades de pointes from QT prolongation

D.Commotio cordis

Explanation: Wolff-Parkinson-White is characterized by a short PR, delta wave (slurred QRS upstroke), and wide QRS from pre-excitation via an accessory pathway. SCD in WPW occurs when atrial fibrillation conducts 1:1 down a rapid accessory pathway, degenerating into ventricular fibrillation. High-risk pathways have shortest R-R < 250 ms in AF. Treatment of pre-excited AF uses procainamide or ibutilide; AV nodal blockers (digoxin, verapamil, adenosine) are contraindicated as they may accelerate AV conduction.

10A patient has a QT of 500 ms at a heart rate of 100 bpm. Using Bazett's formula (QTc = QT / sqrt(RR)), what is the QTc?

A.445 ms

B.500 ms

C.577 ms

D.645 ms

Explanation: Bazett's formula: QTc = QT / sqrt(RR in seconds). At HR 100, RR = 0.6 s, sqrt(0.6) = 0.775. QTc = 500/0.775 ~ 645 ms. Wait — recalculating: 500/0.775 = 645 ms. QTc > 500 ms is high risk for torsades. Bazett over-corrects at high rates and under-corrects at low rates; Fridericia (QT/RR^1/3) is more accurate across heart rates. The correct value here is 645 ms, which is markedly prolonged.

About the ABIM Cardiology Exam

The ABIM Cardiovascular Disease subspecialty certification validates expertise in adult clinical cardiology across coronary artery disease, acute coronary syndromes, heart failure/cardiomyopathy, arrhythmias, valvular heart disease, congenital heart disease in adults, pericardial disease, systemic and pulmonary hypertension, vascular disease, preventive cardiology, and cardio-oncology. Candidates must hold ABIM Internal Medicine certification and complete an ACGME-accredited 3-year cardiovascular disease fellowship.

Questions

100 scored questions

Time Limit

1.5 days total (four 2-hour sessions + two ~2h 15m sessions)

Passing Score

Criterion-referenced (pass/fail; specific cut not published by ABIM)

Exam Fee

~$2,985 initial certification exam fee (American Board of Internal Medicine (ABIM))

ABIM Cardiology Exam Content Outline

21.5%

Coronary Artery Disease

Stable angina (CCS class), ACS (STEMI D2B <=90 min, NSTEMI TIMI/GRACE), DAPT duration (>=12 mo post-ACS DES), ticagrelor/prasugrel/clopidogrel + CYP2C19, FFR <=0.80 / iFR <=0.89, ISCHEMIA/PROMISE/SCOT-HEART, vasospastic and microvascular angina, SCAD.

17%

Heart Failure and Cardiomyopathy

HFrEF four-pillar GDMT (ARNI, beta-blocker, MRA, SGLT2i), HFpEF (EMPEROR-Preserved, DELIVER), HCM (obstruction, mavacamten, septal reduction, SCD-HCM risk), cardiac amyloidosis (PYP, tafamidis), sarcoidosis, myocarditis, takotsubo, peripartum, cardiogenic shock (SCAI A-E), MCS (IABP, Impella, ECMO, LVAD).

15%

Arrhythmias

AV blocks and pacemaker indications, AF (CHA2DS2-VASc + DOAC preferred, CASTLE-AF ablation in HFrEF, LAAO Watchman), SVT (adenosine 6-12-12), VT/VF (ICD primary post-MI 40d + EF<=35%, secondary after VF), channelopathies (Brugada, LQT1-3, CPVT), torsades (Mg sulfate), cardioversion TEE/48 h rule.

15%

Valvular Disease

AS (peak V >=4 / mean >=40 / AVA <=1.0, LFLG-AS dobutamine stress), TAVR vs SAVR (PARTNER 3, Evolut Low Risk), AR (holodiastolic flow reversal), MS (MVA <=1.5, PBMV), MR primary vs secondary (EROA >=0.40), MitraClip (COAPT vs MITRA-FR), endocarditis Duke criteria, mechanical valve INR targets.

13%

Hypertension, Vascular & Pericardial Disease

2017 ACC/AHA HTN >=130/80 stage 1, resistant HTN workup, pregnancy HTN (labetalol/hydralazine/nifedipine), AAA screening (male 65-75 ever-smoker), Stanford A/B dissection, pericarditis ECG (diffuse STE + PR depression), tamponade vs constriction (septal bounce, annulus reversus).

10%

ECG & ECG Equivalents

STEMI localization, RV involvement V4R, posterior MI V1-V2 reciprocal + V7-V9, de Winter T waves, Wellens type A/B, Sgarbossa + Smith-modified (ST/S <= -0.25), paced rhythm MI criteria, Brugada type 1/2/3, WPW delta wave, Bazett vs Fridericia QTc.

8.5%

Preventive Cardiology, Pregnancy & Congenital

ASCVD 10-yr + risk enhancers (Lp(a), hs-CRP, CAC), high-intensity statin (atorva 40-80 / rosuva 20-40), ezetimibe, PCSK9i (alirocumab, evolocumab), inclisiran, bempedoic acid, colchicine (LoDoCo2), mWHO classes I-IV, peripartum CM, adult CHD (BAV, TOF, Eisenmenger, Fontan).

How to Pass the ABIM Cardiology Exam

What You Need to Know

Passing score: Criterion-referenced (pass/fail; specific cut not published by ABIM)
Exam length: 100 questions
Time limit: 1.5 days total (four 2-hour sessions + two ~2h 15m sessions)
Exam fee: ~$2,985 initial certification exam fee

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABIM Cardiology Study Tips from Top Performers

1Drill ECG patterns daily: STEMI localization, RV involvement (V4R), posterior MI (V1-V2 reciprocal, V7-V9 confirmation), de Winter, Wellens types A/B, Sgarbossa + Smith-modified (ST/S <= -0.25), Brugada type 1, WPW delta wave, and Bazett vs Fridericia QTc calculation.

2Memorize the four pillars of HFrEF GDMT (ARNI, beta-blocker, MRA, SGLT2i) and expansions to HFpEF (EMPEROR-Preserved, DELIVER). For HCM, know Mavacamten trials (EXPLORER-HCM, VALOR-HCM) and SCD risk factors (wall >=30 mm, syncope, FHx SCD, NSVT, abnormal BP response).

3Internalize valvular thresholds: severe AS (Vmax >=4 m/s, mean gradient >=40, AVA <=1.0), severe MR primary (EROA >=0.40, RVol >=60 mL), severe MS (MVA <=1.5), holodiastolic flow reversal for severe AR, AVR indications in asymptomatic AR (EF <55% or LVESDi >25 mm/m2).

4Tackle AF systematically: CHA2DS2-VASc >=2 men / >=3 women = OAC, DOAC preferred over warfarin in NVAF, CASTLE-AF/CABANA-HF ablation in HFrEF (Class I 2023 guideline), Watchman in bleeding contraindication, cardioversion <48 h vs TEE rule, rate vs rhythm (RACE II, AFFIRM).

5For preventive cardiology, master high-intensity statins (atorva 40-80, rosuva 20-40), risk enhancers (Lp(a), hs-CRP, CAC, FHx, ethnicity), PCSK9i (alirocumab/evolocumab — FOURIER/ODYSSEY), inclisiran (ORION, every 6 months SC), ezetimibe (IMPROVE-IT), bempedoic acid (CLEAR Outcomes), colchicine 0.5 mg (LoDoCo2, COLCOT), and 2022 USPSTF aspirin update (no primary prevention >=60).

Frequently Asked Questions

Who is eligible for the ABIM Cardiovascular Disease certification exam?

Candidates must hold ABIM board certification in Internal Medicine and have satisfactorily completed an ACGME-accredited 3-year (36-month) Cardiovascular Disease fellowship. Program directors verify clinical competence. An unrestricted US medical license is required. Continuous certification in Internal Medicine is required to maintain the subspecialty credential.

How is the ABIM Cardiology exam structured?

The exam is composed of up to 240 single-best-answer multiple-choice questions, of which approximately 40 are non-scored pretest items. Testing spans 1.5 days: one day with four 2-hour sessions (~10 hours total) of MCQs, plus two additional ~2-hour 15-minute sessions on a separate day, with optional 20-minute breaks between sessions. It is computer-delivered at Pearson VUE centers.

What is the fee for the ABIM Cardiology exam?

The ABIM CV Disease initial certification exam fee is approximately $2,985 in 2026 (confirm current amount on the ABIM fees page). Late registration fees and rescheduling fees apply. Review courses and question banks typically add $1,000-$3,000.

What topics carry the most weight on the ABIM CV blueprint?

The 2026 ABIM CV blueprint weights Coronary Artery Disease (21.5%), Heart Failure and Cardiomyopathy (17%), Arrhythmias (15%), and Valvular Disease (15%) most heavily. Systemic Hypertension (7.5%), Vascular Disease (6%), Congenital Heart Disease (5%), Pericardial Disease (4%), Systemic Disorders Affecting Circulation (4%), Pulmonary Circulation (3%), and Normal CV Anatomy/Physiology (2%) round out the blueprint.

How long should I study for the ABIM Cardiology exam?

Most fellowship graduates report 400-600 hours of dedicated study over 6-10 months. A typical plan allocates ~30% to CAD/ACS, ~25% to HF/cardiomyopathy/shock, ~25% to arrhythmias and valves, and ~20% to preventive cardiology, hypertension, pericardial, vascular, CHD, and PH. High-yield ECG practice and a daily question-bank habit are essential.

What is the pass rate for the ABIM Cardiovascular Disease exam?

Recent first-attempt pass rates for US cardiovascular disease fellowship graduates have ranged approximately 88-92% in recent years, per ABIM's published statistics. Rates vary year to year and are lower for retakers and international/repeat candidates. Completing a structured review course and a large question bank correlates with higher success.

Is the traditional 10-year exam still required, or can I use the LKA?

ABIM now offers two pathways for continuous certification in Cardiovascular Disease: the traditional 10-year recertification exam, or the Longitudinal Knowledge Assessment (LKA) — quarterly untimed question sets streamed over 5-year cycles. Most diplomates starting in 2026 choose the LKA for flexibility. Initial certification still uses the traditional 1.5-day exam.

Does the ABIM CV exam include ECG and imaging interpretation?

Yes — many questions incorporate ECGs, cardiac imaging (echo, CMR, CCTA, coronary angiograms), hemodynamic tracings, and occasional heart sounds. Mastering ECG patterns (STEMI equivalents, Sgarbossa, Wellens, Brugada, WPW, LQTS), core echo measurements (AS severity, EROA, PHT, LV function), and CMR patterns (LGE in sarcoidosis, amyloidosis, HCM) is high-yield.