ARDMS Adult Echocardiography Exam: The Complete Guide (2026)
Last Updated: January 2026 | Reading Time: 20 minutes
Quick Summary: The ARDMS Adult Echocardiography (AE) exam is a 180-question, 3-hour specialty exam required to earn the RDCS credential in adult cardiac sonography. With comprehensive coverage of cardiac anatomy, pathology, and hemodynamic assessment, proper preparation is essential. This guide covers everything you need: exam format, content domains, 10 free practice questions, registration steps, and proven study strategies.
Table of Contents
- What is the Adult Echocardiography Exam?
- Adult Echocardiography Exam Format & Structure
- Understanding the 5 Content Domains
- Free Adult Echocardiography Practice Test Questions
- Adult Echocardiography Exam Scoring & Pass Rate
- How to Register for the Adult Echocardiography Exam
- What to Expect on Exam Day
- How Long Should You Study?
- Tips to Pass the Adult Echocardiography Exam
- FAQs
What is the Adult Echocardiography Exam?
Why the Adult Echocardiography is Challenging
The Adult Echocardiography is often considered one of the more challenging exams because:
- Clinical complexity: Cardiac pathology involves understanding hemodynamics, pressure gradients, and the interrelationship between cardiac structures
- Quantitative assessment: You must know normal values, measurement techniques, and when findings are clinically significant
- Broad pathology coverage: 46% of the exam focuses on recognizing and understanding various cardiac diseases
- Integration of concepts: Questions often require combining anatomy, physiology, and pathology knowledge to select the best answer
Adult Echocardiography Exam Format & Structure
Understanding the exam format helps you prepare strategically:
| Aspect | Details |
|---|---|
| Total Questions | Approximately 165 multiple-choice |
| Time Limit | 3 hours (180 minutes) |
| Passing Score | 555 (on a 300-700 scale) |
| Format | Multiple choice and hotspot questions with echocardiographic images |
| Testing Centers | Pearson VUE (in-person or online proctoring) |
| Exam Fee | $300 (as of 2026) |
Understanding the 5 Content Domains
The Adult Echocardiography exam is divided into 5 content domains, each weighted differently. Knowing these weights helps you prioritize your study time.
Content Domain Weights
Question estimates based on total question count. Focus study time proportionally.
Study tip: Spend the most time on the largest domain—it makes up the biggest portion of your exam.
Domain 1: Anatomy and Physiology (17%)
Approximately 28 questions
Domain 2: Pathology (46%)
Approximately 76 questions
Domain 3: Clinical Care and Safety (8%)
Approximately 13 questions
Domain 4: Measurement Techniques, Maneuvers, and Sonographic Views (23%)
Approximately 38 questions
Domain 5: Instrumentation, Optimization, and Contrast (6%)
Approximately 10 questions
Stroke Volume (SV) = LVOT VTI × LVOT Area
Cardiac Output (CO) = SV × Heart Rate
LVOT Area = π × (LVOT diameter/2)²
Ejection Fraction (EF) = (EDV - ESV) / EDV × 100%
Continuity Equation: AVA = (LVOT Area × LVOT VTI) / AV VTI
Simplified Bernoulli: ΔP = 4V²
PISA: EROA = (2πr² × Aliasing Velocity) / Peak MR Velocity
Pressure Half-Time (MVA): MVA = 220 / PHT
Free Adult Echocardiography Practice Test Questions
Test your knowledge with these sample Adult Echocardiography exam questions. Answers and explanations are provided below.
Question 1
A patient has an LVOT diameter of 2.0 cm, LVOT VTI of 22 cm, and aortic valve VTI of 88 cm. What is the calculated aortic valve area?
Question 2
Which finding is most consistent with severe aortic stenosis?
Question 3
What is the normal range for left ventricular ejection fraction?
Question 4
In the assessment of diastolic function, an E/A ratio < 0.8 with a deceleration time > 200 ms suggests:
Question 5
Which echocardiographic view best demonstrates the mitral valve leaflets for assessment of mitral valve prolapse?
Question 6
A patient presents with acute chest pain. Echo shows a dilated aortic root with an intimal flap in the ascending aorta. What is the most likely diagnosis?
Question 7
In tricuspid regurgitation, the peak TR velocity is 3.2 m/s with an estimated RA pressure of 10 mmHg. What is the estimated systolic pulmonary artery pressure?
Question 8
Which finding is characteristic of hypertrophic cardiomyopathy (HCM)?
Question 9
What is the recommended method for measuring left atrial size?
Question 10
During a stress echocardiogram, which finding indicates myocardial ischemia?
Answer Key with Explanations
Using the continuity equation: LVOT Area = π × (2.0/2)² = 3.14 cm². AVA = (3.14 × 22) / 88 = 0.79 cm². This indicates severe aortic stenosis (AVA < 1.0 cm²).
Severe aortic stenosis is defined by peak velocity ≥4.0 m/s, mean gradient ≥40 mmHg, or AVA ≤1.0 cm². A peak velocity of 4.5 m/s with mean gradient of 50 mmHg clearly meets severe criteria.
Normal LVEF is 52-72% for men and 54-74% for women according to ASE guidelines. An EF below 52% in men or 54% in women indicates reduced systolic function.
Grade I diastolic dysfunction (impaired relaxation) is characterized by E/A ratio < 0.8, prolonged deceleration time (>200 ms), and reduced e' velocity. This pattern reflects impaired LV relaxation.
The parasternal long-axis view is optimal for assessing mitral valve prolapse because it provides a true long-axis view of the mitral annular plane. The apical views can create false-positive prolapse due to the saddle shape of the mitral annulus.
An intimal flap in the aortic lumen with a dilated aortic root in a patient with acute chest pain is highly suggestive of aortic dissection. This is a medical emergency requiring immediate intervention.
Using the modified Bernoulli equation: RVSP = 4V² + RAP = 4(3.2)² + 10 = 4(10.24) + 10 = 40.96 + 10 = approximately 51 mmHg. In the absence of pulmonic stenosis, RVSP equals systolic PAP.
HCM is characterized by asymmetric septal hypertrophy (septal thickness ≥15 mm), systolic anterior motion (SAM) of the mitral valve, and often dynamic LVOT obstruction. The LV cavity is typically small with hyperdynamic function.
LA volume indexed to body surface area (LAVi) is the recommended method per ASE guidelines, as the LA often enlarges asymmetrically. Normal LAVi is ≤34 mL/m². The biplane method of discs using apical 4- and 2-chamber views is preferred.
A new or worsening regional wall motion abnormality (hypokinesis, akinesis, or dyskinesis) during stress indicates inducible myocardial ischemia. Normal response to stress is augmentation of wall motion and increased EF.
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Adult Echocardiography Exam Scoring & Pass Rate
Current Pass Rates
According to official data, the Adult Echocardiography first-time pass rate is approximately 70%. This makes it one of the more challenging exams.
Why Pass Rates May Be Lower
- Extensive pathology coverage: 46% of the exam tests your knowledge of cardiac diseases and their echocardiographic findings
- Quantitative requirements: You must memorize normal values, severity criteria, and measurement techniques
- Clinical correlation: Questions often require integrating findings with clinical scenarios
- Complex hemodynamics: Understanding pressure gradients, flow dynamics, and their calculations is essential
Understanding Your Score Report
Your score report includes:
- Overall scaled score (pass/fail)
- Performance breakdown by content domain
- Percentile ranking compared to other examinees
What If You Don't Pass?
First, know that you're not alone—many examinees don't pass on their first attempt.
- Waiting period: 60 days before you can retake
- Maximum attempts: 3 attempts per 12-month period
- Re-application: You must submit a new application and fee for each attempt
How to Register for the Adult Echocardiography Exam
Step 1: Create an ARDMS Account
Visit myARDMS.org, create a new account or log in, and complete your profile information.
Step 2: Ensure SPI Completion
You must pass the SPI exam before or concurrently with your specialty exam. Many candidates take SPI first while physics is fresh.
Step 3: Verify Your Eligibility
ARDMS offers several pathways to AE exam eligibility:
- Pathway 1: Graduate from a CAAHEP-accredited cardiac sonography program
- Pathway 2: Currently enrolled in final year of accredited program
- Pathway 3: Hold CCI (RCS) credential or equivalent
- Pathway 4: Documented clinical cardiac sonography experience (typically 12-24 months)
Step 4: Submit Your Application
Select 'Adult Echocardiography (AE)' from available exams, choose your eligibility pathway, upload required documentation (transcripts, clinical hours verification), and pay the examination fee ($275 as of 2026).
Step 5: Receive Your Authorization to Test (ATT)
ARDMS reviews applications within 2-4 weeks. Upon approval, you'll receive an ATT via email valid for 90 days.
Step 6: Schedule with Pearson VUE
Visit Pearson VUE, choose in-person or online proctoring, select your preferred date and time, and confirm your appointment.
What to Expect on Exam Day
For In-Person Testing
Before arrival:
- Get 7-8 hours of sleep the night before
- Eat a balanced meal to maintain energy for 3 hours
- Arrive 30 minutes early to allow time for check-in
- Bring two forms of valid ID (one with photo and signature)
At the testing center:
- Check in with the test administrator
- Store personal belongings in a locker (no phones, watches, or notes)
- Palm vein scan or photo may be taken for security
During the exam:
- You'll receive scratch paper for calculations
- Pace yourself: 180 questions in 180 minutes = 1 minute per question
- Breaks are permitted but count against your exam time
- Flag difficult questions and return to them if time permits
For Online Proctoring
System requirements:
- Reliable high-speed internet connection
- Webcam and microphone (built-in or external)
- Windows or Mac computer (tablets not permitted)
- Quiet, private room with no interruptions
Environment requirements:
- Clear desk (remove all items except computer)
- No dual monitors allowed
- Well-lit room so proctor can see you clearly
- No one else may enter the room during testing
How Long Should You Study?
The ideal study timeline depends on your background:
| Situation | Recommended Study Time |
|---|---|
| Current echo student (didactic fresh) | 8-10 weeks |
| Recent graduate (< 1 year) | 10-12 weeks |
| Working sonographer with echo experience | 8-10 weeks |
| Transitioning from another specialty | 12-16 weeks |
Sample Study Schedule
Week 1-2: Anatomy & Physiology Foundation
- Review cardiac anatomy: chambers, valves, great vessels
- Study normal cardiac physiology and the cardiac cycle
- Master standard echocardiographic views and image orientation
- Complete 150-200 practice questions on Domain 1
Complete 150-200 practice questions
Week 3-4: Valvular Heart Disease
- Study aortic stenosis and regurgitation: criteria, grading, causes
- Study mitral stenosis and regurgitation: PISA, vena contracta, PHT
- Review tricuspid and pulmonic valve pathology
- Practice severity grading and hemodynamic calculations
Complete 200-250 practice questions
Week 5-6: Cardiomyopathies & LV Function
- Study dilated, hypertrophic, and restrictive cardiomyopathies
- Master EF calculation methods: biplane Simpson's, visual estimation
- Review diastolic function assessment and grading
- Study regional wall motion abnormalities and coronary distribution
Complete 200-250 practice questions
Week 7-8: Additional Pathology & Measurements
- Study pericardial disease: effusion, tamponade, constriction
- Review cardiac masses, thrombi, and vegetations
- Master all standard measurements and normal values
- Study aortic disease: aneurysm, dissection, coarctation
Complete 200 practice questions
Week 9-10: Instrumentation & Final Review
- Review Domains 4 and 5: techniques, optimization, contrast
- Take 2-3 full-length timed practice exams
- Review all missed questions and weak areas
- Light review of key formulas and normal values
Complete 250+ practice questions
Tips to Pass the Adult Echocardiography Exam
1. Master the Pathology (46% of the Exam)
Nearly half the exam tests pathology knowledge. Know the echocardiographic findings, severity criteria, and hemodynamic consequences of common cardiac diseases. Create flashcards for each condition.
2. Memorize Severity Criteria
Know the cutoff values for mild, moderate, and severe disease for all valvular lesions. For example: severe AS = peak velocity ≥4.0 m/s, mean gradient ≥40 mmHg, or AVA ≤1.0 cm².
3. Practice Hemodynamic Calculations
Be able to quickly calculate AVA (continuity equation), pressure gradients (Bernoulli), cardiac output, and pulmonary pressures. Practice these calculations until they become second nature.
4. Know Your Views
Understand which structures are best visualized in each echocardiographic view and which measurements are obtained from each view. Know the proper technique for each standard view.
5. Understand Diastolic Function
Diastolic dysfunction assessment is a common exam topic. Know the grading system (Grades I-III), the parameters used (E/A ratio, e' velocity, E/e' ratio, TR velocity), and how to integrate them.
6. Pace Yourself During the Exam
With 180 questions in 180 minutes, you have exactly 1 minute per question. Don't spend too long on difficult questions; flag them and return if time permits. Answer every question.
FAQs
How many questions are on the Adult Echo exam?
The AE exam contains approximately 165 multiple-choice questions.
What is the passing score for the Adult Echo exam?
You need a scaled score of 555 or higher (on a 300-700 scale) to pass.
How long is the Adult Echo exam?
You have 3 hours (180 minutes) to complete the exam, averaging 1 minute per question.
What is the Adult Echo exam pass rate?
The current first-time pass rate is approximately 70%.
How much does the Adult Echo exam cost?
The examination fee is $275 (as of 2026).
Do I need to pass the SPI before taking the Adult Echo exam?
Yes, the SPI exam is required for all ARDMS credentials. You can take them in any order, but both must be passed to earn your RDCS credential.
How many times can I take the Adult Echo exam?
You can attempt the exam up to 3 times within a 12-month period with a mandatory 60-day waiting period between attempts.
What content domain should I focus on most?
Domain 2 (Pathology) accounts for 46% of the exam and should receive the most study time. However, don't neglect the other domains.
Can I use a calculator during the exam?
A basic on-screen calculator is provided. Practice your calculations without a scientific calculator to prepare for exam conditions.
Related ARDMS Exam Guides
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This guide is updated regularly to reflect the latest ARDMS Adult Echocardiography exam information. Last reviewed: January 2026.