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The cardiology boards are ABIM’s Cardiovascular Disease Certification Examination, and they come in two parts: a full-day multiple-choice exam of up to 240 questions, and a half-day exam on electrocardiograms and imaging studies of up to 75 (ABIM blueprint). Most fellows pass. In 2025, 86% of 1,209 first-time takers did, and the rate has held at 85% to 86% for five years (ABIM pass rates).
That still means about one in seven first-time takers fails. This guide covers what each part tests, where ABIM puts the weight, and how to fit a review into the last year of fellowship.
Exam format at a glance
| Topic | Official rule | Source |
|---|---|---|
| Format | Two components: a full-day multiple-choice exam, and a half-day electrocardiograms and imaging studies exam. | ABIM: Cardiovascular Disease blueprint (CERT) |
| Questions | Multiple-choice part: up to 240 single-best-answer questions, about 40 of them unscored. ECG and imaging part: up to 75 questions, about 10 unscored. | ABIM: Cardiovascular Disease blueprint (CERT) |
| Scoring | Standardized score scale from 200 to 800 with a mean of 500; pass or fail is decided on the whole exam against an absolute standard set by the specialty board. | ABIM: how exams are scored |
The multiple-choice part
The full-day exam tests the knowledge, diagnostic reasoning and judgement expected of a certified cardiologist, including rare problems a patient might be referred for (ABIM blueprint). About 40 of the up to 240 questions are new and unscored, and you cannot tell which ones. Many questions include pictures: ECGs, intracardiac electrograms, hemodynamic tracings, angiograms, echo clips, perfusion studies, CT and MRI, and some recorded heart sounds.
| Blueprint category | Share of MCQ exam |
|---|---|
| Coronary artery disease | 21.5% |
| Heart failure and cardiomyopathy | 17% |
| Arrhythmias | 15% |
| Valvular disease | 15% |
| Systemic hypertension and hypotension | 7.5% |
| Vascular diseases | 6% |
| Congenital heart disease | 5% |
| Pericardial disease | 4% |
| Systemic disorders affecting the circulation | 4% |
| Pulmonary circulation disorders | 3% |
| Normal anatomy and physiology | 2% |
Source: ABIM Cardiovascular Disease blueprint, May 2026. Coronary disease, heart failure, arrhythmias and valves together make up more than two-thirds of the exam. A review that covers those four well and treats the rest as a checklist matches the blueprint.
The ECG and imaging part
ABIM says it is very important to understand this part ahead of time, because it is not built from ordinary multiple-choice questions (ABIM blueprint). Each case gives a brief patient description and one or more images, and you mark your findings on a long, fixed list of possible ECG, echocardiogram or angiogram findings. The weight is electrocardiograms 48%, echocardiograms 37% and coronary angiograms 15%.
The answer lists in ABIM’s sample cases and tutorial are exactly the lists used on the exam. Work through them until you know where each finding sits, so test-day time goes on reading the tracing, not hunting through the list. Daily ECG reading through the year does more for this half than a cram in the final month.
How the cardiology boards are scored
ABIM reports a standardized score from 200 to 800, with a mean of 500, and decides pass or fail on the whole examination against an absolute standard set by the specialty board (ABIM scoring). There is no curve: in principle everyone in a year can pass. Your report also shows performance by content area, which is the place to start if you need a second attempt.
For context, interventional cardiology, the next exam many fellows sit, had a 90% first-time pass rate among 343 takers in 2025 (ABIM pass rates), and across ABIM’s initial certification exams the ultimate pass rate is 98% (ABIM).
Planning a cardiology board review in fellowship
- Start from the blueprint, not a course. Rank the eleven categories by your confidence and plan the weeks from the bottom of the list. Coronary disease at 21.5% deserves its share even if it is your daily work.
- Keep the two parts separate. Question banks train the MCQ day. The ECG and imaging day needs its own practice on ABIM’s findings lists.
- Practise images inside questions. Hemodynamic tracings and electrograms appear in the MCQ part too, and they are where fellows from programs with less exposure lose time.
- Simulate a full day. At least once, sit a timed full-length set to learn where your focus drops.
- Book review weeks around your rotation calendar, with lighter months before the exam if your program allows it.
A board review course can be useful for structure. It does not replace timed questions and your own review of each miss.
Cardiology review with a tutor
Our tutor for cardiology is Dr. David Wadie, a third-year cardiology fellow and Chief Cardiology Fellow at Henry Ford Providence Hospital, board certified in internal medicine and through the Adult Echocardiography board exam. He works with residents and cardiology fellows on the reasoning behind an answer rather than memorized facts. Read his profile, or see how we approach ABIM internal medicine prep.