Requires:  Passing (or receiving exemption from) the Cardiovascular Science Examination and passing the Invasive Registry Examination

Who should apply?  Professionals working in the area of Cardiac Catheterization (Invasive)

RCIS Specialty Examination Fee: $200
*All Registry Level candidates must either pass or be granted exemption from the Cardiovascular Science Examination in addition to passing the specific Registry Level Examination before being awarded a registry level credential (RCIS, RCS, or RVS).

Cardiovascular Science Examination: $185 (Click here to be directed to that section)

Self Assessment Booklets can be ordered for all CCI examinations. An order form can be found on the last page of the Application.

Examination Matrix

CONTENT CATEGORY AND APPROX. PERCENTAGE OF EXAM

Detailed Outline

A. Cardiovascular Anatomy and Physiology

I. Innervation
ccccca. Conduction system
cccccb. Sympathetic
cccccc. Parasympathetic
II. Coronary Anatomy
III. Physiology
ccccca. Pressure and pulse waveforms
cccccb. Hemodynamic parameters
cccccc. Frank-Starling principle
cccccd. Contractility
ccccce. Preload and afterload
cccccf. Electrophysiology – action potential
cccccg. Normal fetal circulation

B. Cardiovascular Diseases Pathophysiology
cccccI. Pathology and treatment
cccccccccca. VaIvular heart disease
ccccccccccb. Myocardial and pericardial disease
ccccccccccc. Artificial valves and surgery
ccccccccccd. Coronary artery disease –atherosclerosis
cccccccccce. Heart failure and shock
ccccccccccf. Myocardial infarction
ccccccccccg. Hereditary disease
ccccccccccccccc1. Pulmonary
ccccccccccccccc2. Arterial
ccccccccccccccc3. Stroke
cccccccccch. Systemic and pulmonary hypertension
cccccccccci. Congenital heart disease
ccccccccccj. Aortic diseases
cccccccccck. Tumors
ccccccccccl. Aneurysms
ccccccccccm. Cerebrovascular accident
ccccccccccn. Ventricular Thrombus
cccccccccco. Cardiac tamponade

II. Acid Base Disturbance
cccccccccca. Respiratory acidosis
ccccccccccb. Respiratory alkalosis
ccccccccccc. Metabolic acidosis
ccccccccccd. Metabolic alkalosis

C. Diagnostic Techniques
cccccI. Catheterization Techniques
cccccccccca. Terminology
ccccccccccb. Protocol
ccccccccccc. Contraindications
ccccccccccd. Preparation and pre-medication
cccccccccce. Complications
ccccccccccf. Arterial lines
ccccccccccg. Cutdown - Sones
cccccccccch. Percutaneous- Seldinger
cccccccccci. Position of catheters in the heart
ccccccccccj. Right heart catheterization
cccccccccck. Left heart catheterization
ccccccccccccccc1. Grafts
cccccccccc1. Coronary
cccccccccc2. Internal mammary
cccccccccc3. Venous
ccccccccccm. Electrophysiology
ccccccccccn. Pediatric
cccccccccco. Hemostasis - closing
ccccccccccp. Exercise
ccccccccccq. Endomyocardial biopsy
ccccccccccr. Provocative maneuvers

III. Electrocardiography
ccccca. Arrhythmias
cccccb. Ischemia, infarction patterns
cccccc. Blocks
cccccd. Measurements, waveforms and calculations
ccccce. Artifacts, techniques
cccccf. Hypertrophy
cccccg. Pacemakers

D. Intervention

I. Techniques and Devices
ccccca. AICD
cccccb. Intra-aortic counter pulsation
cccccc. Cardiopulmonary support circulation
cccccd. Intravascular ultrasound
ccccce. Doppler flow wire
cccccf. Pacemakers
cccccccccc1. Temporary
ccccccccccccccca. Transvenous
cccccccccccccccb. Transcutaneous
cccccccccc2. Permanent
ccccccccccccccca. Indications
cccccccccccccccb. Implantation
II. Defibrillation and Cardioversion
III. Percutaneous Transluminal Angioplasty
IV. Thrombolytic Therapy

V. Surgical Correction
ccccca. Congenital heart disease
cccccb. Coronary bypass
cccccc. VaIvular repair
VI. Valvuloplasty
VII. Pericardiocentesis
VIII. Stents
IX. Atherectomy
X. Laser

E. Hemodynamic Data

I. Cardiac Output Determinations
ccccca. Fick
cccccb. Angiographic
cccccc. Thermaldilution
cccccd. Comparison of methods
ccccce. Shunts
cccccf. Regurgitant fraction
cccccg. Ejection fraction
II. Calculations
ccccca. Oxygen capacity
cccccb. AV02 difference
cccccc. Cardiac output
cccccd. Systemic and pulmonary resistance
ccccce. Systemic and pulmonary blood flow
cccccf. Shunts
cccccg. Regurgitant fraction
ccccch. Ejection fraction
ccccci. Valve area
cccccj. Normal calculated values
III. Pressures
ccccca. Normal and abnormal –waveforms, pressure levels, etc.
cccccb. Time pressure relationships
cccccc. Pullback identification
cccccd. VaIvular gradients
ccccce. Insufficient valves
cccccf. Constrictive/restrictive pressures
cccccg. Heart failure pressures
ccccch. Provocative maneuvers
ccccci. Pressure analysis

F. Pharmacology

I. Drug Classifications
ccccca. Adrenergic
cccccb. Cholinergic
cccccc. Vasopressors
cccccd. Vasodilators
ccccce. Diuretics
cccccf. Antihypertensives
cccccg. Local anesthetics
ccccch. Anticoagulants
ccccci. Antiplatelet
cccccj. Thrombolytics
ccccck. Nitrates
ccccc1. Antiarrythmics
cccccm. Calcium channel blockers
cccccn. Contrast agents
cccooo. Cardiac glycosides
cccccp. Controlled substances
cccccq. Oxygen
cccccr. Beta blockers
II. Types and Administration Routes
ccccca. Indications and Contra indications
cccccb. Preparation and Dosage
cccccc. Complications
cccccd. Actions
III. Contrast Administration
ccccca. Types and properties of contrast agents
cccccb. Indications and Contraindications
IV. IV Therapy
ccccca. Indications and Contraindications
cccccb. Venipuncture
cccccc. Solution Preparation
cccccd. Flow Rate
ccccce. Complications

G. Equipment and Instrumentation

I. Radiographic Equipment
ccccca. Cine Cameras
cccccb. Operating Console
cccccc. X-ray Tube
cccccd. X-ray Oenerator, Rectifier, and Transformer
ccccce. Automatic Exposure Controls
cccccf. Beam Restriction Devices
cccccg. Basic Principles of X-Ray Production
ccccch. Recognition of Malfunctions
ccccci. Fluoroscopic Timer
cccccj. Electrical Hazards
II. Film Processing
ccccca. Film Storage
cccccb. Screens and Cassettes
cccccc. Radiographic Identification
cccccd. Film Processor
III. Automatic Pressure Injectors
ccccca. Parts
cccccb. Function
cccccc. Operation
IV. Catheters, Guidewires, Needles
ccccca. Types
cccccb. Construction
cccccc. Use
V. Implantable Devices
ccccca. Caval Filters
cccccb. Central Venous Catheters
cccccc. Embolic Materials
cccccd. Stents
ccccce. Permanent Pacemakers and Defibrillators
VI. Cardiac Output Equipment
VII. Pressure Recorders
VIII. Temporary Pacemakers
IX. External Defibrillators
X. Transducers
XI. Quality Control
ccccca. Concepts and Principles of Quality Control
cccccccccc1. Basis of QC
cccccccccc2. Problem Solving Strategies
cccccb. Collection & Analysis of QC Data
cccccccccc1. Development of Indicators
cccccccccc2. Data Collection Methods
cccccccccc3. Data Analysis
cccccccccc4. Assessment of Outcomes
cccccccccc5. Required QC Tests
cccccccccc6. Frequency of QC Tests
cccccccccc7. Suggested Performance Criteria for QC Tests
cccccc. Evaluation of Radiographic images
cccccccccc1. Criteria for Diagnostic Quality
cccccccccc2. Improving Radiographic Quality
cccccccccc3. Image Characteristics
cccccccccc4. Image Production
cccccccccc5. Image Display
cccccd. Film Processors
ccccce. Test Objects
cccccccccc1. Sensitometer
cccccccccc2. Densitometer
cccccccccc3. Light meter
cccccf. Transducers
cccccccccc1. Balance
cccccccccc2. Preparation
cccccg. Lab Equipment
cccccccccc1. Oximeter
cccccccccc2. ACT

H. Patient Care and Patient Assessment

I. Evaluation and assessment
ccccca. Signs and symptoms of heart disease
cccccccccc1. Arterial and venous pulses
cccccccccc2. Auscultation and murmurs
cccccb. Central nervous system assessment
II. Documentation and catheterization protocols
III. Arterial and venous line management
IV. Hemostasis
V. Legal and Professional Responsibilities
ccccca. Patient identification
cccccb. Verification of requested examination
cccccc. Legal and medical ethics
VI. Patient Education, Safety and Comfort
ccccca. Communication with patients
cccccb. Assessment of patient condition
cccccc. Proper body mechanics for patient transfer
cccccd. Patient privacy
ccccce. Prevention and Control of Infection
cccccccccc1. Transmission of Infection
cccccccccc2. Universal precautions
cccccccccc3. Disinfection, Asepsis, and Sterile Technique
cccccccccc4. Handling of Biohazardous Materials
cccccccccc5. Type of Isolation
VII. Emergency Procedures
ccccca. Patient Monitoring
cccccb. Contrast reactions and complications
cccccc. Protocol, treatment and medications
cccccd. Cardiopulmonary Resuscitation (CPR)
ccccce. Advanced Cardiac Life Support (ACLS)
cccccccccc1. Universal algorithm
cccccccccc2. Defibrillation and cardioversion
cccccccccc3. Airway management
cccccccccc4. Pharmacology
VIII. Patient Assessment Implications, normal and abnormal values
ccccca. Vital Signs
cccccb. Access assessment (venous and arterial)
cccccc. Normal Lab Values
cccccd. Lab Results
cccccccccc1. Electrolytes
cccccccccc2. Blood gases
cccccccccc3. Blood chemistry
ccccce. Physiologic Monitoring
cccccf. Maintenance of Accessory Medical Devices
IX. Radiation Protection
ccccca. Patient Protection
cccccb. Biological Effects of Radiation
cccccc. Minimizing Patient Exposure
cccccd. Personnel Protection
cccccccccc1. Sources of radiation exposure
cccccccccc2. Basic methods of protection
cccccccccc3. Radiation exposure and monitoring
ccccca. Units of measurement
cccccb. Dosimeters (types, proper use)
cccccc. NCRP Recommendations for Personnel Monitoring

Sample Questions

1. Based on the following data: O2 Consumption = 250 ml/min., AO = 21.0 vol. %, PA = 16.0 vol. %, BSA = 1.8 M2. What is the approximate cardiac output for the patient?
a. 2.5 L/min.
b. 4.0 L/min.
c. 5.0 L/min.
d. 6.0 L/min.

2. Based on the following data: O2 Consumption = 250 ml/min., AO = 21.0 vol. %, PA = 16.0 vol. %, BSA = 1.8 M2. What is the approximate cardiac index for the patient?
a. 2.22 L/min./M2
b. 2.77 L/min./M2
C. 3.00 L/min./M2
d. 3.33 L/min./M2

3. If T-wave sensing occurs in ventricular demand or synchronous pacing, what must be done to the programmable generator?
a. Increase pulse width
b. Decrease pulse width
c. Longer refractory period
d. A shorter refractory period

4. If a patient had a large S-wave in lead VI and a large R-wave in V5, you might suspect:
a. LVH
b. IV Strain
c. Hyperkalemia
d. Anterior Infarction

5. What is most likely indicated from the following oximetry samples?
Position, Saturation%, Position, Saturation%
SVC, 70%, RV, 86%
IVC, 71%, PA, 86%
Hi RA, 78%, LA, 94%
Mid RA, 86%, LV, 94%
Low RA, 83%, AO, 94%

a. ASD with left to right shunt
b. PDA with left to right shunt
c. VSD with left to right shunt
d. Tetralogy of Fallot with bidirectional shunt

6. On an ECG, which of the following may indicate a loose connection of a temporary pacing wire at the pulse generator spikes?
a. Changing in size
b. Changing in polarity
c. Decreasing in intervals
d. Falling at irregular intervals

7. Which of the following will markedly elevate right ventricular systolic pressure?
a. Infundibular stenosis
b. Pulmonic insufficiency
c. Constrictive pericarditis
d. Patent ductus arteriosus

8. Which of the following may be caused by rapid accumulation of fluid in the pericardial sac?
a. Subvalvular gradient
b. Coarctation gradient
c. Atrioventricular gradient
d. Semilunar valve gradient

9.  A patient has a cardiac output of 5 L/min. and a heart rate of 75 beats per minute. If stroke volume remains constant, what will be the effect of an increase in heart rate to 150 beats per minute? Cardiac output would:
a. Triple
b. Increase to 10 L/min.
c. Increase to 25 L/min.
d. Increase to 22.5 L/min.

10.  Cardiac myxomas are usually located in the:
a. Left atrium
b. Right atrium
c. Left ventricle
d. Right ventricle

11.  Overdrive suppression of Torsade de Pointes and atrial flutter works by pacing the heart according to which of the following protocols:
a. With bursts at same rate as the tachycardia
b. 10-20 beats/minute slower than the tachycardia
c. 10-40 beats/minute faster than the intrinsic HR
d. With premature synchronized extra systoles Sl-S2

12.  What is the BEST indicator of the exact moment the aortic and pulmonary valves open?
a. R wave on the ECG
b. C wave on the atrial pressure tracing
c. Dicrotic notch on the atrial pressure waveform
d. Beginning of systolic rise on the arterial pressure

13.  Left ventricular mass is determined angiographically from measuring the heart wall thickness during what stage of the cardiac cycle?
a. Mid-systole
b. End-systole
c. Mid-diastole
d. End-diastole

14.  In an aortic pressure recording, a gradual upstroke with a prominent low anacrotic notch is indicative of:
a. Aortic stenosis
b. Aortic insufficiency
c. Left ventricular failure
d. Congestive heart failure

15.  Which of the following is characteristic of Tetralogy of Fallot?
a. Greater pressure in the left ventricle
b. A fall in pressure form the ventricle to aorta
c. A marked difference in mean atrial pressures
d. A fall in pressure from right ventricle to the pulmonary artery

16.  In an aortic pressure recording, a rapid upstroke with a large pulse pressure is indicative of:
a. Mitral stenosis
b. Aortic stenosis
c. Aortic insufficiency
d. Constrictive pericarditis

17.  Protection from radiation may be maximized by all but which of the following:
a. Significantly reducing KV setting
b. Maximizing the distance to the source
c. Minimizing the time near the radiation source
d. Placing absorbing material between yourself and the patient

18.  What is MOST likely indicated by the following pressures?
RV = 26/2, PA= 25/19, LA = mean of 18, LV = 142/8, AO = 145/75?
a. Mitral stenosis
b. Aortic stenosis
c. Mitral insufficiency
d. Aortic insufficiency

19.  In cardiac tamponade, venous pressures:
a. fall and arterial pressures rise
b. rise and arterial pressures fall
c. remain steady and arterial pressures fall
d. rise and arterial pressure remains steady

20.  Which of the following typically increases to compensate for constrictive diseases which impede filling:
a. SV
b. Preload
c. Afterload
d. EDV, ESV

Answers:
1. c cccc5. a cccc  9. b ccc13. d   17. a
2. b ccc 6. d cccc10. a ccc14. a   18. a
3. c cccc7. a cccc11. cccc 15. d    19. b
4. a cccc8. c cccc12. d cc 16. c     20. b

References
1. Student Manual for Basic Life Support, American Heart Association.
2. Textbook of Advanced Cardiac Life Support, American Heart Association.
3. Cardiac Catheterization and Angiography, 6th edition, Grossman, William, Lea and Febiger, Philadelphia, PA.
4. Techniques in Bedside Hemodynamic Monitoring, 5th edition, Elaine Daily, RN, BS, and John Schroed, MDCV, 1994,
    Mosby Co., Washington, DC.
5. Cardiac Arrhythmias: Electrophysiologic Techniques and Management, 1st edition, Dreifus, L.S., 1985;
    F.A. Davis Co., Philadelphia, PA.
6. Cardiac Catheterization Handbook, 3rd edition, Morton Kern, MD, 1999, C.V. Mosby, St. Louis, Missouri.
7. Texts of Basic Electronics, Mathematics, CPR, Anatomy, Physiology and Nursing Care of the Cardiovascular Patient.

8. The Manual of Intervention Cardiology, 2nd Edition, Mark Freed, MD, Cindy Grimes, MD, Robert D. Safian, MD 1996,
    Physicians Press, Birmingham, Michigan
9. Invasive Cardiology: A Manual for Cath Lab Personnel, Sandy Watson, Physicians Press, Birmingham, Michigan.

Credentials Main