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Cardiovascular Disease
Certification Examination Blueprint

What Does the Examination Cover?
The exam is designed to evaluate the extent of the candidate's knowledge and clinical judgment
in the areas in which cardiologists should demonstrate a high level of competence. Expertise in
the broad domain of cardiovascular disease and the diagnosis and treatment of both common
and rare conditions that have important consequences for patients, will be assessed.

Exam content is consistent with a pre-established blueprint, or table of specifications. The
blueprint is developed by the Subspecialty Board on Cardiovascular Disease and is reviewed
and revised annually to ensure that it is current. In addition, practicing cardiologists,
cardiovascular disease trainees, and training program directors are surveyed periodically to
provide feedback on the blueprinting process. The blueprint is used as a guide in developing
the exam.

The majority of questions (over 75 percent) are based on patient presentations occurring in
settings that reflect current medical practice. Questions requiring simple recall of medical facts
are in the minority; the majority of questions require integration of information from several
sources, prioritization of alternatives, and/or utilization of clinical judgment in reaching a correct
conclusion. Some questions require interpretation of pictorial material including
electrocardiograms, intracardiac electrograms, hemodynamic recordings, chest radiographs,
photomicrographs, and imaging studies such as coronary angiograms, echocardiograms,
myocardial perfusion studies, magnetic resonance images, and intravascular ultrasound
images.

Topics covered may include the following:
    Anatomy and pathology
    Preventive and rehabilitative cardiology
    Epidemiology and ethics
    Cardiovascular disease in women
    Geriatric cardiovascular disease
    Preoperative assessment for noncardiac surgery
    Postoperative cardiac care
    Critical care medicine, cardiovascular surgery, and general internal medicine as
       encountered in the practice of cardiology (including some general pediatrics with an
       emphasis on adolescent medicine)
The content areas covered and their relative proportions on the exam are as follows:


                           Medical Content         Relative Percentage
                               Category
                       Arrhythmias                         13.0
                       Coronary artery disease             12.5
                       Acute coronary                      12.0
                       syndromes/Acute
                       myocardial infarction
                       Valvular disorders                  12.0
                       Congenital disorders                5.0
                       Pericardial disease                  4.0
                       Aorta/Peripheral                     9.0
                       vascular disease
                       Hypertension/Pulmonary              7.0
                       disorders
                       Pharmacology                         5.0
                       Congestive heart failure            13.0
                       Physiology/Biochemistry              6.0
                       Miscellaneous                        1.5
                       Total                              100%
Content Outline of the Certification Examination

This content outline describes a typical Cardiovascular Disease Certification Examination;
actual content on a specific examination may vary. Each medical content category from the
examination blueprint is listed in boldface below, along with target blueprint percentage and total
number of questions in the category. Within each category, the approximate distribution of
questions in specified areas is also listed.

                        Medical Content Category                                Number
                         (Relative Percentage)                               of Questions
    Arrhythmias (13%)                                                      23-26 as follows:
       Atrial fibrillation/Atrial flutter                                         3-6
       Ventricular arrhythmias/Sudden cardiac death/Wide QRS                      3-7
       complex tachycardias/ICD indications, malfunctions, and
       interactions
       Paroxysmal supraventricular tachycardias/Wolff-Parkinson-                   2-4
       White syndrome
       Antiarrhythmic drug indications, interactions, and effects                  2-4
       Pacemaker indications, management, malfunctions, and                        2-4
       interactions
       Electrophysiologic testing/Noninvasive electrocardiographic                 2-4
       testing
       Syncope/Sinus node dysfunction/AV block/Bundle branch                       0-1
       block
       Miscellaneous arrhythmias, such as arrhythmias in pregnancy                 0-2


    Coronary artery disease (12.5%)                                        22-26 as follows:
      Medical management, including ICU care and long-term                        2-4
      management of stable and unstable angina, thrombotic
      conditions, and vasomotor function
      Noninvasive testing, including ECG, stress echo, stress                      2-4
      nuclear, stress MR, CT, EBCT
      Revascularization, including periprocedural management (PCI,                 4-6
      surgery)
      Invasive testing (coronary angiography, left ventricular                     1-3
      function); Appropriate use criteria for catheterization and PCI
      Symptom recognition (normal function, stable angina, unstable                0-2
      angina) including age and sex differences
      Primary and secondary prevention, including therapy and risk                 2-4
      factor recognition and management (lipid abnormalities,
      metabolic syndrome, systemic hypertension, etc.)
      Pre- and postoperative assessment and management of                          1-3
      noncardiac surgery
Acute coronary syndromes/Acute myocardial infarction (12%)              22-26 as follows:
  Reperfusion therapy, including percutaneous transluminal                     4-6
  coronary arteriography, thrombolysis, and anticoagulation
  Complications, including arrhythmias, shock, continued                       4-7
  ischemia/ Mechanical support devices
  Symptom recognition/diagnosis, including age, sex, and race                  2-5
  Medical management (preadmission, inpatient, perisurgical,                   2-4
  postdischarge), including monitoring and rehabilitation
  Risk stratification, including noninvasive testing and differential          1-4
  demographic outcomes
  Primary and secondary prevention specifically related to                     1-3
  ACS/AMI

Valvular disorders (12%)                                                23-25 as follows:
  Prostheses/Repair, including indications and short- and long-                4-7
  term management
  Mitral regurgitation/Mitral stenosis                                         3-7
  Aortic regurgitation/Aortic stenosis/Mixed                                   3-6
  Endocarditis                                                                 1-2
  Valvular hemodynamics and physiology                                         0-2
  Miscellaneous (eg, physician examination)                                    0-2
  Tricuspid/Pulmonary                                                          0-1

Congenital disorders (5%)                                               10-12 as follows:
  Shunts, including atrial septal defect, ventricular septal defect,           4-8
  patent foramen ovale, Eisenmenger syndrome, and tetralogy
  of Fallot
  Valvular defects, including Ebstein’s anomaly, pulmonary                    2-4
  valve stenosis, bicuspid aortic valve, and transposition of the
  great vessels
  Vascular defects, including coarctation of the aorta and                    0-2
  transposition of the great vessels
  Syndromes with cardiovascular implications, including Down,                 0-2
  Holt-Oram, Noonan, Turner, Williams, etc.

Pericardial disease (4%)                                                 6-8 as follows:
  Pericardial effusion and tamponade                                           1-4
  Acute pericarditis                                                           1-2
  Pericardial constriction and effusive-constrictive pericarditis              1-2
  Miscellaneous, including congenital absence of pericardium,                  1-2
  pericardial cysts, pericardial tumors, and metastatic disease

Aorta/Peripheral vascular disease (9%)                                  15-18 as follows:
  Peripheral arterial occlusive disease, diagnosis and therapy                 3-6
  (pharmacologic, interventional, surgical)
  Aortic disorders, including dissection and aneurysm                         3-6
  Stroke, diagnosis and therapy (pharmacologic, interventional,               2-4
  surgical)
  Vasculitis, including Buerger, Takayasu, giant cell arteritis,              2-4
SLE, polyarteritis nodosa, and Kawasaki
  Miscellaneous, including antiphospholipid antibody syndrome,            0-2
  idiopathic lymphedema, and retroperitoneal bleeding
  Venous disorders                                                        0-2

Hypertension/Pulmonary disorders (7%)                               13-15 as follows:
  Primary and secondary causes of hypertension, diagnosis,                 5-9
  and complications of treatment
  Pulmonary hypertension (primary and secondary), pulmonary               1-4
  embolism
  Severe/malignant hypertension                                           1-3
  Hypertension in pregnancy (eclampsia)                                   0-2
  Sleep disorders                                                         0-2

Pharmacology (5%)                                                   10-13 as follows:
  Drug indications                                                         2-4
  Adverse effects                                                          3-5
  Mechanisms of action                                                     1-4
  Drug interactions                                                        1-4
  Pharmacokinetics                                                         0-1
  Alternative medicines/Dietary supplements                                0-1


Congestive heart failure (13%)                                      23-28 as follows:
  Cardiomyopathy, including dilated, hypertrophic, and                     5-8
  infiltrative/restrictive
  Systolic dysfunction, including diagnosis, therapy, and natural         4-7
  history
  Diastolic dysfunction, including diagnosis, therapy, and                3-5
  natural history
  Unstable heart failure (acute, decompensated)                           2-4
  Devices and surgical approaches                                         2-4
  Transplantation                                                         2-4
  Diagnostic tests                                                        0-2
  Miscellaneous, including physiology, basic mechanisms                   0-2
  (molecular, cellular, biochemical), comorbid factors, and
  complications

Physiology/Biochemistry (6%)                                        11-13 as follows:
  Vascular physiology                                                      2-4
  Myocardial physiology                                                    2-4
  Metabolic/Molecular/Genetic                                              2-4
  Other                                                                    0-2

Miscellaneous (1.5%)                                                 2-4 as follows:
  Study design/Literature interpretation                                   1-3
  Ethics/Malpractice                                                       0-2

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Cardiovascular Disease Certification Examination Blueprint

  • 1. Cardiovascular Disease Certification Examination Blueprint What Does the Examination Cover? The exam is designed to evaluate the extent of the candidate's knowledge and clinical judgment in the areas in which cardiologists should demonstrate a high level of competence. Expertise in the broad domain of cardiovascular disease and the diagnosis and treatment of both common and rare conditions that have important consequences for patients, will be assessed. Exam content is consistent with a pre-established blueprint, or table of specifications. The blueprint is developed by the Subspecialty Board on Cardiovascular Disease and is reviewed and revised annually to ensure that it is current. In addition, practicing cardiologists, cardiovascular disease trainees, and training program directors are surveyed periodically to provide feedback on the blueprinting process. The blueprint is used as a guide in developing the exam. The majority of questions (over 75 percent) are based on patient presentations occurring in settings that reflect current medical practice. Questions requiring simple recall of medical facts are in the minority; the majority of questions require integration of information from several sources, prioritization of alternatives, and/or utilization of clinical judgment in reaching a correct conclusion. Some questions require interpretation of pictorial material including electrocardiograms, intracardiac electrograms, hemodynamic recordings, chest radiographs, photomicrographs, and imaging studies such as coronary angiograms, echocardiograms, myocardial perfusion studies, magnetic resonance images, and intravascular ultrasound images. Topics covered may include the following:  Anatomy and pathology  Preventive and rehabilitative cardiology  Epidemiology and ethics  Cardiovascular disease in women  Geriatric cardiovascular disease  Preoperative assessment for noncardiac surgery  Postoperative cardiac care  Critical care medicine, cardiovascular surgery, and general internal medicine as encountered in the practice of cardiology (including some general pediatrics with an emphasis on adolescent medicine)
  • 2. The content areas covered and their relative proportions on the exam are as follows: Medical Content Relative Percentage Category Arrhythmias 13.0 Coronary artery disease 12.5 Acute coronary 12.0 syndromes/Acute myocardial infarction Valvular disorders 12.0 Congenital disorders 5.0 Pericardial disease 4.0 Aorta/Peripheral 9.0 vascular disease Hypertension/Pulmonary 7.0 disorders Pharmacology 5.0 Congestive heart failure 13.0 Physiology/Biochemistry 6.0 Miscellaneous 1.5 Total 100%
  • 3. Content Outline of the Certification Examination This content outline describes a typical Cardiovascular Disease Certification Examination; actual content on a specific examination may vary. Each medical content category from the examination blueprint is listed in boldface below, along with target blueprint percentage and total number of questions in the category. Within each category, the approximate distribution of questions in specified areas is also listed. Medical Content Category Number (Relative Percentage) of Questions Arrhythmias (13%) 23-26 as follows: Atrial fibrillation/Atrial flutter 3-6 Ventricular arrhythmias/Sudden cardiac death/Wide QRS 3-7 complex tachycardias/ICD indications, malfunctions, and interactions Paroxysmal supraventricular tachycardias/Wolff-Parkinson- 2-4 White syndrome Antiarrhythmic drug indications, interactions, and effects 2-4 Pacemaker indications, management, malfunctions, and 2-4 interactions Electrophysiologic testing/Noninvasive electrocardiographic 2-4 testing Syncope/Sinus node dysfunction/AV block/Bundle branch 0-1 block Miscellaneous arrhythmias, such as arrhythmias in pregnancy 0-2 Coronary artery disease (12.5%) 22-26 as follows: Medical management, including ICU care and long-term 2-4 management of stable and unstable angina, thrombotic conditions, and vasomotor function Noninvasive testing, including ECG, stress echo, stress 2-4 nuclear, stress MR, CT, EBCT Revascularization, including periprocedural management (PCI, 4-6 surgery) Invasive testing (coronary angiography, left ventricular 1-3 function); Appropriate use criteria for catheterization and PCI Symptom recognition (normal function, stable angina, unstable 0-2 angina) including age and sex differences Primary and secondary prevention, including therapy and risk 2-4 factor recognition and management (lipid abnormalities, metabolic syndrome, systemic hypertension, etc.) Pre- and postoperative assessment and management of 1-3 noncardiac surgery
  • 4. Acute coronary syndromes/Acute myocardial infarction (12%) 22-26 as follows: Reperfusion therapy, including percutaneous transluminal 4-6 coronary arteriography, thrombolysis, and anticoagulation Complications, including arrhythmias, shock, continued 4-7 ischemia/ Mechanical support devices Symptom recognition/diagnosis, including age, sex, and race 2-5 Medical management (preadmission, inpatient, perisurgical, 2-4 postdischarge), including monitoring and rehabilitation Risk stratification, including noninvasive testing and differential 1-4 demographic outcomes Primary and secondary prevention specifically related to 1-3 ACS/AMI Valvular disorders (12%) 23-25 as follows: Prostheses/Repair, including indications and short- and long- 4-7 term management Mitral regurgitation/Mitral stenosis 3-7 Aortic regurgitation/Aortic stenosis/Mixed 3-6 Endocarditis 1-2 Valvular hemodynamics and physiology 0-2 Miscellaneous (eg, physician examination) 0-2 Tricuspid/Pulmonary 0-1 Congenital disorders (5%) 10-12 as follows: Shunts, including atrial septal defect, ventricular septal defect, 4-8 patent foramen ovale, Eisenmenger syndrome, and tetralogy of Fallot Valvular defects, including Ebstein’s anomaly, pulmonary 2-4 valve stenosis, bicuspid aortic valve, and transposition of the great vessels Vascular defects, including coarctation of the aorta and 0-2 transposition of the great vessels Syndromes with cardiovascular implications, including Down, 0-2 Holt-Oram, Noonan, Turner, Williams, etc. Pericardial disease (4%) 6-8 as follows: Pericardial effusion and tamponade 1-4 Acute pericarditis 1-2 Pericardial constriction and effusive-constrictive pericarditis 1-2 Miscellaneous, including congenital absence of pericardium, 1-2 pericardial cysts, pericardial tumors, and metastatic disease Aorta/Peripheral vascular disease (9%) 15-18 as follows: Peripheral arterial occlusive disease, diagnosis and therapy 3-6 (pharmacologic, interventional, surgical) Aortic disorders, including dissection and aneurysm 3-6 Stroke, diagnosis and therapy (pharmacologic, interventional, 2-4 surgical) Vasculitis, including Buerger, Takayasu, giant cell arteritis, 2-4
  • 5. SLE, polyarteritis nodosa, and Kawasaki Miscellaneous, including antiphospholipid antibody syndrome, 0-2 idiopathic lymphedema, and retroperitoneal bleeding Venous disorders 0-2 Hypertension/Pulmonary disorders (7%) 13-15 as follows: Primary and secondary causes of hypertension, diagnosis, 5-9 and complications of treatment Pulmonary hypertension (primary and secondary), pulmonary 1-4 embolism Severe/malignant hypertension 1-3 Hypertension in pregnancy (eclampsia) 0-2 Sleep disorders 0-2 Pharmacology (5%) 10-13 as follows: Drug indications 2-4 Adverse effects 3-5 Mechanisms of action 1-4 Drug interactions 1-4 Pharmacokinetics 0-1 Alternative medicines/Dietary supplements 0-1 Congestive heart failure (13%) 23-28 as follows: Cardiomyopathy, including dilated, hypertrophic, and 5-8 infiltrative/restrictive Systolic dysfunction, including diagnosis, therapy, and natural 4-7 history Diastolic dysfunction, including diagnosis, therapy, and 3-5 natural history Unstable heart failure (acute, decompensated) 2-4 Devices and surgical approaches 2-4 Transplantation 2-4 Diagnostic tests 0-2 Miscellaneous, including physiology, basic mechanisms 0-2 (molecular, cellular, biochemical), comorbid factors, and complications Physiology/Biochemistry (6%) 11-13 as follows: Vascular physiology 2-4 Myocardial physiology 2-4 Metabolic/Molecular/Genetic 2-4 Other 0-2 Miscellaneous (1.5%) 2-4 as follows: Study design/Literature interpretation 1-3 Ethics/Malpractice 0-2