Cardiology Board Prep for Family Medicine

Five-minute daily sessions on the cardiology topics that actually show up on the ABFM. Built around current ACC/AHA, JNC, and ACCP guidelines.

Cardiology is consistently one of the largest content areas on the ABFM Family Medicine certification exam, typically accounting for 10 to 12 percent of questions. That density reflects how much cardiovascular disease shows up in a real family medicine practice — hypertension is in nearly every chart, lipid management touches most adults over 40, and atrial fibrillation is increasingly common as panels age. The board exam tests whether you can apply guideline-driven decisions to the patient in front of you, not whether you can recite ejection fraction cutoffs from memory.

The good news: ABFM cardiology questions reward clinical reasoning over esoteric trivia. You will not be asked about percutaneous valve techniques or advanced electrophysiology. You will be asked when to start an ACE inhibitor, how to titrate guideline-directed medical therapy in HFrEF, what to do with an asymptomatic 60-year-old whose LDL is 165, and how to manage a patient with new-onset atrial fibrillation at the bedside. The 2017 ACC/AHA hypertension guidelines, 2018 cholesterol guidelines, 2022 AHA/ACC/HFSA heart failure guidelines, and the 2023 ACC chronic coronary disease guidelines are the four documents that drive most cardiology questions on the test.

A few framing principles will help you study efficiently. First, board questions almost always include a brief vignette with vital signs, labs, and sometimes an EKG description. Pay close attention to the patient's age, race, ejection fraction, kidney function, and concurrent diagnoses — these details often dictate the correct answer. Second, ABFM tends to test the most evidence-supported next step rather than the most aggressive intervention. When in doubt, lean toward guideline-recommended therapy with the strongest mortality benefit. Third, the test favors recognizing classic patterns: a patient with crushing chest pain, diaphoresis, and ST elevations is having a STEMI; a patient with progressive dyspnea, JVD, and bilateral crackles has decompensated heart failure; a patient with palpitations and an irregularly irregular pulse has atrial fibrillation until proven otherwise.

Finally, remember that family medicine cardiology is mostly outpatient and preventive. The exam will test secondary prevention more than acute MI management, chronic stable angina more than acute coronary syndrome inpatient care, and risk stratification more than catheterization decisions. Spend your time on outpatient management of hypertension, dyslipidemia, heart failure, atrial fibrillation, and stable coronary disease — that is where the points live.

High-yield cardiology topics

• First-line antihypertensive selection per 2017 ACC/AHA. For non-Black patients without compelling indications, ACE inhibitor, ARB, calcium channel blocker, or thiazide are all first-line. For Black patients without heart failure or CKD, start with a CCB or thiazide. Goal BP is under 130/80 for most adults.
• HFrEF guideline-directed medical therapy (the four pillars). Per 2022 AHA/ACC/HFSA guidelines, every patient with EF under 40 percent should be on an ARNI (or ACE/ARB), beta-blocker (carvedilol, metoprolol succinate, or bisoprolol), MRA (spironolactone or eplerenone), and an SGLT2 inhibitor. All four reduce mortality.
• Statin initiation per 2018 ACC/AHA cholesterol guidelines. High-intensity statin for clinical ASCVD, LDL over 190, or diabetes with high risk. For primary prevention age 40 to 75, calculate 10-year ASCVD risk: under 5 percent no statin, 5 to 7.5 percent consider, 7.5 to 20 percent moderate-intensity, over 20 percent high-intensity.
• Atrial fibrillation rate vs rhythm control and CHA2DS2-VASc. Rate control with beta-blocker or non-dihydropyridine CCB is appropriate for most stable patients. Anticoagulate based on CHA2DS2-VASc: men with score of 2 or more, women with score of 3 or more. DOACs are preferred over warfarin except in mechanical valves or moderate-to-severe mitral stenosis.
• Stable angina workup and chronic coronary disease management. Per 2023 ACC chronic coronary disease guidelines, start with stress testing (exercise ECG if normal baseline EKG and able to exercise; stress imaging if otherwise). Optimize medical therapy first: aspirin, high-intensity statin, beta-blocker, and SL nitroglycerin PRN. Add ACE/ARB if hypertension, diabetes, or LV dysfunction.
• Acute coronary syndrome recognition and triage. STEMI on EKG mandates immediate cath lab activation with door-to-balloon under 90 minutes. NSTEMI and unstable angina are treated with dual antiplatelet (aspirin plus ticagrelor or clopidogrel), anticoagulation, beta-blocker, statin, and risk stratification with TIMI or GRACE score.
• Murmur evaluation and when to order an echocardiogram. Echocardiogram is indicated for any diastolic murmur, late or pansystolic murmur, grade 3 or louder systolic murmur, or any murmur with symptoms. Innocent flow murmurs in young, asymptomatic patients with normal EKG do not require echo.
• Preoperative cardiac risk assessment using RCRI. Use the Revised Cardiac Risk Index for non-cardiac surgery: high-risk surgery, ischemic heart disease, heart failure, stroke, insulin-dependent diabetes, creatinine over 2. With 0 to 1 risk factors and good functional capacity (over 4 METs), proceed without further testing.

ABFM exam tips

Read the vital signs first. ABFM cardiology vignettes embed the answer in the numbers. A patient with BP 165/95 and proteinuria almost certainly needs an ACE/ARB. A patient with heart rate 130 and irregular rhythm is in atrial fibrillation with rapid ventricular response and needs rate control before anything else.

Memorize the four heart failure pillars. ARNI, beta-blocker, MRA, SGLT2 inhibitor for HFrEF. If a question shows a patient with reduced EF and asks what is missing from their regimen, the answer is whichever of those four is not listed. SGLT2 inhibitors now have indication regardless of diabetes status — this is a heavily tested update.

Know the 2017 ACC/AHA blood pressure stages cold. Normal: under 120/80. Elevated: 120 to 129 systolic and under 80 diastolic. Stage 1: 130 to 139 or 80 to 89. Stage 2: 140 or higher or 90 or higher. ASCVD risk over 10 percent triggers pharmacologic therapy at stage 1; otherwise lifestyle first.

Recognize EKG patterns described in words. "ST elevation in leads II, III, aVF" is inferior STEMI — check for right ventricular involvement and avoid nitrates if hypotensive. "Diffuse ST elevation with PR depression" is pericarditis. "Irregularly irregular without P waves" is atrial fibrillation.

Pick guideline-recommended therapy over aggressive intervention. The ABFM rewards "start the ACE inhibitor and recheck in two weeks" more than "refer immediately to cardiology." Family medicine is the home of primary and secondary prevention — the exam reflects that.

For lipids, anchor on the 2018 guidelines. High-intensity statin means atorvastatin 40 to 80 or rosuvastatin 20 to 40. Moderate-intensity means atorvastatin 10 to 20, rosuvastatin 5 to 10, simvastatin 20 to 40. The exam tests whether you pick the right intensity for the right risk category.

Common pitfalls

Do not confuse HFpEF with HFrEF management. Heart failure with preserved ejection fraction (EF over 50 percent) does not respond to the four-pillar therapy the way HFrEF does. For HFpEF, treat hypertension aggressively, manage volume with diuretics, and add an SGLT2 inhibitor. Do not put every HFpEF patient on a beta-blocker and ARNI — the evidence is not there.

Stop using JNC 7 numbers. The 2017 ACC/AHA guidelines lowered the hypertension threshold to 130/80. If a question stems references JNC 7 or older targets like "under 140/90 for everyone," it is testing whether you know the current standard. Use 130/80 unless the question explicitly references an older guideline.

Do not anticoagulate based on AFib alone. A patient with paroxysmal atrial fibrillation and CHA2DS2-VASc of 0 in men or 1 in women does not need anticoagulation. Conversely, do not stop anticoagulation just because the patient converted to sinus rhythm — the stroke risk persists.

Avoid non-dihydropyridine CCBs in HFrEF. Diltiazem and verapamil are negative inotropes and worsen heart failure with reduced ejection fraction. They are fine for rate control in AFib with preserved EF, but contraindicated when EF is below 40 percent.

Do not over-test stable, low-risk chest pain. A 30-year-old with reproducible chest wall tenderness and a normal EKG does not need a stress test. The ABFM tests whether you can avoid unnecessary workups as much as whether you can pursue appropriate ones.

Beta-blockers are not contraindicated in COPD. Cardioselective beta-blockers like metoprolol succinate and bisoprolol are safe and beneficial in COPD patients with cardiac indications. The old teaching about "absolute contraindication" is wrong and is sometimes tested.

Statin doses changed after 2013. The exam will not ask you to titrate to an LDL goal; it asks you to pick the right intensity based on risk category. Old "treat to target" thinking will lead you astray.

Frequently asked questions

What cardiology topics are most tested on the ABFM?

Hypertension management, heart failure (especially HFrEF guideline-directed therapy), lipid management, atrial fibrillation (rate control and stroke prevention), and stable coronary disease account for the majority of cardiology questions. Acute coronary syndrome appears but less often than outpatient topics. Pre-operative cardiac assessment and murmur evaluation round out the high-yield list.

How many cardiology questions are on the ABFM exam?

Cardiovascular content typically makes up 10 to 12 percent of the ABFM certification exam, which translates to roughly 30 to 40 questions across a full exam. This makes it one of the three largest content areas alongside endocrine and musculoskeletal. The In-Training Exam follows a similar distribution.

Should I use specialty-specific resources for ABFM cardiology?

Probably not. Specialty references like UpToDate cardiology sections or Braunwald go far deeper than the ABFM tests. Stick with family medicine board prep materials that emphasize ACC/AHA outpatient guidelines, the 2017 hypertension guidelines, the 2018 cholesterol guidelines, and the 2022 heart failure guidelines. PulseMD focuses on exactly this scope.

Which guidelines should I prioritize for cardiology board prep?

In rough order of yield: 2017 ACC/AHA hypertension guidelines, 2018 ACC/AHA cholesterol guidelines, 2022 AHA/ACC/HFSA heart failure guidelines, 2023 ACC chronic coronary disease guidelines, and the 2023 ACC/AHA atrial fibrillation guidelines. The USPSTF recommendations on aspirin and statin primary prevention are also tested.

How do I memorize EKG findings for the boards?

You do not need to read raw tracings on the ABFM. Questions describe EKG findings in words: "ST elevation in II, III, aVF" or "irregularly irregular rhythm without P waves." Focus on recognizing the verbal descriptions for STEMI by location, AFib, AV blocks, hyperkalemia (peaked T waves, widened QRS), and pericarditis.

Are SGLT2 inhibitors really first-line for heart failure now?

Yes. The 2022 heart failure guidelines added SGLT2 inhibitors as one of the four pillars of HFrEF therapy regardless of diabetes status. Empagliflozin and dapagliflozin reduce heart failure hospitalization and cardiovascular mortality. Recent ABFM exams have tested this aggressively, and many older study materials are out of date on this point.

What is the best way to study cardiology for boards in five-minute daily sessions?

Focus on one topic per session and pair it with two or three practice questions that test application. Spaced repetition works especially well for cardiology because the guidelines have many discrete decision rules — antihypertensive selection, statin intensity, anticoagulation thresholds — that benefit from repeated short exposures rather than marathon study.