10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
These 10 free AHFTC questions are organized by exam domain, so you can see how each part of the Advanced Heart Failure and Transplant Cardiology blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Heart Failure 40% of exam
Question 1
On hospital day 3, a 64-year-old man with LVEF 25% has lost 3.5 kg during intravenous furosemide treatment. Orthopnea has improved, but jugular venous pressure remains 12 cm H2O and bilateral leg edema persists. Creatinine has increased from 1.4 to 1.8 mg/dL. Blood pressure is 112/70 mm Hg, extremities are warm, lactate is 1.2 mmol/L, and urine output remains brisk. There has been no contrast exposure or other new nephrotoxin. How should decongestion proceed?
Show answer & explanation
Correct answer: C - Continue intravenous loop diuresis with renal and electrolyte monitoring.
Question 2
A 75-year-old man with progressive heart failure, increased LV wall thickness, and previous bilateral carpal tunnel surgery undergoes technetium-99m pyrophosphate scintigraphy. Grade 3 uptake is confirmed to be myocardial on SPECT. Serum immunofixation detects an IgG-kappa monoclonal protein; urine immunofixation is negative. No tissue diagnosis has been obtained. Before selecting disease-specific therapy, which investigation is needed to establish the cardiac amyloid type?
Show answer & explanation
Correct answer: C - Endomyocardial biopsy with definitive typing of the deposited amyloid protein.
Question 3
At a medication-optimization visit, a 59-year-old man with symptomatic HFrEF and LVEF 29% takes sacubitril/valsartan 24/26 mg twice daily, metoprolol succinate 100 mg daily, and furosemide. He is euvolemic. Blood pressure is 102/64 mm Hg without orthostasis, sinus rate is 58/min, eGFR is 38 mL/min/1.73 m2, and potassium is 5.3 mmol/L on two nonhemolyzed samples. HbA1c is 5.6%. A higher sacubitril/valsartan dose previously caused symptomatic hypotension. Which change offers an appropriate additional disease-modifying treatment now?
Show answer & explanation
Correct answer: B - Add dapagliflozin 10 mg once daily.
Question 4
Exertional dyspnea remains unexplained in a 67-year-old woman with obesity and hypertension. LVEF is 64%, valve function is normal, NT-proBNP is 86 pg/mL, and her H2FPEF score is 4. Hemoglobin, pulmonary function testing, and an ischemia evaluation are unrevealing. Resting catheterization shows mean pulmonary artery pressure 18 mm Hg, wedge pressure 11 mm Hg, and normal cardiac output. Which test would best determine whether abnormal cardiac filling pressures cause her symptoms during activity?
Show answer & explanation
Correct answer: D - Supine exercise right-heart catheterization with wedge-pressure measurement.
Question 5
A structural heart consultation is requested for a 66-year-old woman with persistent NYHA class III symptoms and severe secondary mitral regurgitation. LVEF is 28%, LV end-systolic diameter is 62 mm, and estimated pulmonary artery systolic pressure is 54 mm Hg. Mitral anatomy is suitable for transcatheter edge-to-edge repair. She has received all four foundational HFrEF drug classes at maximally tolerated doses for 6 months. ECG shows sinus rhythm with LBBB and QRS duration 172 ms; she has no resynchronization device. Which intervention should be prioritized at this stage?
Show answer & explanation
Correct answer: A - Cardiac resynchronization therapy, then reassessment of mitral severity.
Domain 2: Mechanical Circulatory Support 30% of exam
Question 6
A patient receiving femoral venoarterial ECMO for cardiogenic shock has improving native LV contraction and more frequent aortic-valve opening, but severe bilateral pulmonary infiltrates persist. With circuit flow unchanged at 4.5 L/min, the right radial PaO2 falls to 49 mm Hg. Simultaneous contralateral femoral arterial and post-oxygenator PaO2 values are 286 and 418 mm Hg, respectively. What accounts for this distribution of oxygenation?
Show answer & explanation
Correct answer: A - Native LV ejection delivers poorly oxygenated blood to the proximal aorta.
Question 7
Eighteen hours after femoral VA ECMO initiation for fulminant myocarditis, mean arterial pressure is 74 mm Hg and lactate has fallen from 7.1 to 1.8 mmol/L. Despite diuresis and ventilator optimization, frothy airway secretions and pulmonary edema are worsening. Echocardiography shows an enlarging LV, LVEF 10%, a persistently closed aortic valve, and spontaneous echo contrast. The circuit is functioning normally. Which intervention addresses the immediate cardiac problem?
Show answer & explanation
Correct answer: B - Establish left-heart venting or another effective LV-unloading strategy.
Question 8
A HeartMate 3 recipient has had a third admission for bleeding from intestinal angioectasias. Endoscopic hemostasis is successful. He takes warfarin with a target INR of 2.0-3.0 and aspirin 81 mg daily; INR at presentation was 2.4. There is no history of pump thrombosis, coronary stenting, or another antiplatelet indication. For the discharge regimen, which antithrombotic change is best supported by device-specific evidence?
Show answer & explanation
Correct answer: C - Discontinue aspirin and maintain warfarin at an INR of 2.0-3.0.
Domain 3: Heart Transplantation 25% of exam
Question 9
Routine surveillance 4 months after heart transplantation identifies an interstitial lymphocytic infiltrate with a single focus of myocyte injury. The biopsy is negative for antibody-mediated rejection. The recipient feels well, LVEF is 63%, right atrial pressure is 4 mm Hg, pulmonary artery wedge pressure is 9 mm Hg, and cardiac index is 2.8 L/min/m2. Tacrolimus is within the prescribed target range, donor-specific antibodies are absent, and previous biopsies showed no rejection. Which management plan fits these findings?
Show answer & explanation
Correct answer: D - Maintain the current immunosuppressive regimen and continue rejection surveillance.
Question 10
During transplant evaluation, a 38-year-old woman with nonischemic cardiomyopathy and two HF admissions in the past year completes cardiopulmonary exercise testing while taking her maximally tolerated beta blocker and other foundational therapy. Peak VO2 is 15.6 mL/kg/min, representing 46% of the age- and sex-predicted value. Respiratory exchange ratio is 1.16 and the VE/VCO2 slope is 39. How should this study influence the candidacy assessment?