How to Pass the ECG and Imaging Section of the Cardiology Board Exam

By Debra L. Beck, MSc  |  August 12, 2022  |  Other

Pass the ECG and Imaging Exam

“You have to pass the coding session to pass the boards. If you ace the multiple-choice section but fail the coding session, you will fail the boards.” Michael W. Cullen, MD (Mayo Clinic Cardiology Board Review Course)

In 2021, the exam pass rate for the American Board of Internal Medicine (ABIM) Initial Certification in Cardiovascular Disease was 86%. The ABIM does not make publicly available pass/fail rates for specific sections of the exam, but it has been suggested that most of those that fail the exam do so because they failed the Electrocardiogram (ECG) and Imaging Studies component of the Initial Exam. 

Are you prepared for the ECG and Imaging Studies component of the Cardiology Board Exam? 

We can help: Both of our Mayo Clinic cardiology board review courses (Cardiology Board Review and CV Updates) include coding practice questions that closely mimic those seen on the board exam. You will be presented with a short patient vignette and the appropriate clinical data (including moving images) to help you sharpen your diagnostic skills. 

After you choose your answers you can access “expert codes” and a short video explanation of the rationale behind the correct answers. Each section also offers learners the opportunity to watch a one- to two-hour-long lesson teaching the basics of each diagnostic modality delivered by expert Mayo Clinic faculty. 

Want to see our exclusive coding content?

Start a free trial of Cardiology Board Review.

More on the ABIM Initial Exam Format

The initial ABIM certification examination in Cardiovascular Disease spans 1.5 days, with the second half-day reserved for the electrocardiograms and imaging studies component of the exam (see below). 

Content Category % of Exam
Electrocardiograms 48%
Echocardiograms 37%

Coronary Angiograms


The ECG and Imaging Studies component of the initial board certification exam will evaluate candidates on their ability to interpret ECGs, echocardiograms, and coronary angiograms. There will be 75 questions (of which about 10 are ‘test’ questions that do not count towards your score). The format comprises a brief patient description and one (or multiple) images. 

The ECG session is two hours followed by an optional 20-minute break. The imaging studies session, comprising echocardiograms and coronary angiograms, is two hours and 15 minutes.

As with the full-day part of the exam, the content is determined by a pre-established blueprint, or table of specifications, reviewed and updated as needed by the ABIM. Learn more about ABIM Certification here. 

The ABIM provides some sample cases to help test takers become more familiar with the exam format, as well as an interactive ECG and Imaging Studies exam tutorial. Test takers are encouraged to complete the tutorial before exam day.

ECG Practice Test
Screenshot of ABIM tutorial

Physicians pursuing recertification (also called maintenance of certification) in cardiovascular medicine are not required to take this portion of the exam. 

Start Practicing ECG Coding

Share this article
Subscribe to Blog