CCT: ECG, Holter Monitoring, and Stress Testing Certification Examination

The Certified Cardiographic Technician (CCT) examination is for professionals working in the areas of ECG, Holter monitoring, and stress testing. This computer based exam is administered at Pearson Professional Centers year-round based on availability at the test centers. To locate a test center click here.

The application fee for the CCT examination is $175 USD. All exam fees include a $100 non-refundable examination filing fee for the staff resources required to review and process applications. {CLICK HERE for Refund and Cancellation Policy}


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CCT Exam Preparation

The CCT examination is designed to assess knowledge and skills to current practice. CCI provides an overview of the examination content including a knowledge and task list. Preparation for CCI examinations can be overwhelming and there are several options that can assist you in your preparation.

The CCT examination is a two-hour, multiple choice exam that contains 130 questions (110 scored and 20 unscored), that contains a mix of traditional and innovative item types. 

1.  Traditional multiple choice – Only one of four possible answers is correct (e.g. A, B, C or D).
2.  Innovative multiple response – Two or three answers are correct from a list of four to six possible answers.  The test taker will be instructed to select a certain number of correct answers (e.g. “Select two correct responses.”)
3.  Innovative hot spot – The test taker will be instructed to click on one specific area of an image to answer the question.  Only one answer (click) is necessary, but it must be in the correct location.
4.  Innovative drag and place – The test taker will be instructed to drag a collection of labels (tokens) into specific boxes or areas on an image.  The correct tokens will need to be placed in the correct boxes in order to get the question right. It’s possible that all tokens may not be used.

The 20 unscored questions are not identified and are randomly distributed throughout the exam to gather performance data. A candidate’s exam score is based on the responses to the 110 scored questions. One hour and fifty (50) minutes are allotted for answering the exam questions and ten (10) minutes are allotted for a pre-exam tutorial and post-exam survey.

The examination content is based on the findings of a Job Task Analysis (JTA) which describes the overall tasks that a CCT is expected to perform on the job and general areas of knowledge that are needed to perform the tasks. Examination content was developed by subject matter experts in the cardiovascular profession. A JTA is performed every 5 years for all nine of the examinations that CCI offers in order to keep exams relevant to current practices in the field.  Examination content was developed by subject matter experts in the cardiovascular profession and ongoing statistical analyses provided by testing professionals with a doctorate in Industrial and Organizational Psychology.

Examination Matrix and Task List: The tasks listed below describe the activities that a cardiographic technician is expected perform on the job. All examination questions are linked to these tasks. The listing also illustrates relative weight or emphasis given to the main content areas on the examination.

Duties and Tasks Approx. % of Exam
A. Conducting Pre-Procedural Activities 10%
  1. Verify physician's orders (e.g., protocol, patient limitations)
  2. Verify patient identifiers (e.g., name, DOB, HIPAA)
  3. Obtain patient consent (e.g., implied consent, informed consent, healthcare proxy)
  4. Apply universal and/or isolation precautions
  5. Perform patient transfer and transport (e.g., body mechanics, ergonomics, proper equipment use)
  6. Identify proper anatomical landmarks
  7. Prepare the patient (e.g., skin preparation, patient positioning)
  8. Confirm equipment calibration, maintenance and cleaning
  9. Identify safety hazards/considerations (e.g., patient, environment)
  10. Provide patient education (e.g., purpose, procedure, expectations, instructions)
B. Performing Resting ECG (12-Lead, 15-Lead, etc.) 39%
  1. Gather ECG supplies and equipment
  2. Troubleshoot while performing ECG
  3. Perform standard 12-Lead ECG
  4. Perform modified ECG (dextrocardia, posterior, right sided, etc.)
  5. Perform 15-Lead, pediatric ECG
  6. Recognize axis deviations
  7. Recognize Bundle Branch Blocks (RBBB/LBBB)
  8. Identify hypertrophy
  9. Correlate ECG morphology with anatomy or physiology
  10. Identify ischemic changes/infarction
C. Performing Stress Tests 10%
  1. Gather stress test supplies and equipment
  2. Demonstrate knowledge of stress test equipment (e.g., treadmill, bicycle, ergometry)
  3. Perform stress test protocol (e.g., Bruce, Modified Bruce, Naughton)
  4. Demonstrate knowledge of pharmacological and/or nuclear stress test protocols
D. Performing Ambulatory Monitoring (Holter, Event, Telemetry, Transtelephonic, Pacemaker, etc.) 4%
  1. Gather ambulatory monitoring supplies and equipment
  2. Verify equipment functionality pre and post patient application
  3. Attach leads to patient (e.g., stress loops, pouch)
  4. Perform ambulatory monitoring equipment and procedure troubleshooting
E. Performing Rhythm Analysis 37%
  1. Analyze sinus rhythm data
  2. Analyze atrial rhythm data
  3. Analyze junctional rhythm data
  4. Analyze heart blocks rhythm data
  5. Analyze ventricular rhythm data
  6. Analyze pacemaker rhythm data
  7. Report/communicate obtained rhythm data
  8. Correlate ECG findings (e.g., waveforms, segments, intervals)
  9. Identify life-threatening arrhythmias
  10. Identify types of artifact
  11. Identify various classes/effects of general cardiovascular medications (beta blockers, ACE inhibitors, anti-arrhythmics, etc.)
TOTAL 100%


Knowledge List
The list below describes general areas of knowledge that are needed in order to perform the tasks identified. This knowledge will apply across multiple tasks.

  • Heart
    • Size
    • Location
    • Layers
    • Chambers
    • Valves
  • Blood flow
  • Arteries
  • Veins
  • Capillaries
  • Arterioles
  • Venules
  • Cardiac valve function
  • Pressures
  • Relationship of cardiac output to heart rate and stroke volume
  • Control mechanisms
  • Cardiac cycle
  • Normal values
  • Waveforms
  • ECG measurement
  • Bipolar, unipolar, and precordial leads
  • Einthoven’s triangle and law
  • ECG calibration methods
  • Single- and three-channel ECG
  • Troubleshooting ECGs
  • Standardization
  • Paper speed
  • Lead placement
  • Electrical interference
  • Somatic tremor

The textbooks listed below are intended as recommended resources when preparing for examination. You may have previous or later editions of these or other references available that also present acceptable coverage of the subject matter. Any general text in cardiovascular techniques and evaluation, and cardiac patient care and management may be used. It is not necessary to use all of the texts identified. They are provided as suggestions only. CCI does not endorse or recommend any third-party review course or material.

  1. Shier, David, Jackie Butler, and Ricki Lewis. Hole’s essentials of human anatomy and physiology. Boston: McGraw-Hill.
  2. Booth, Kathryn A., and Thomas E. O’Brien. Electrocardiography for healthcare professionals. New York: McGraw-Hill.
  3. Dubin, Dale. Rapid interpretation of EKG’s: an interactive course. 6th ed. Tampa, Fla.: Cover Pub. Co., 2000.
  4. Wagner, Galen S., and Henry J. L. Marriott. Marriott’s Practical Electrocardiography. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Self-Assessment Practice Examination
Click here to order Self-Assessment Practice Exams

CCI has prepared the online self-assessment exams to help exam candidates gauge their knowledge of the content areas on the exam and determine in which areas they may have strengths and weaknesses. The self-assessment exam contains sample items covering the approximate proportion of subject matter to match the CCI exam matrix. These items serve as a sample representation of the type of questions you can expect to see on the actual exam.

CCI’s self-assessment exams do not provide a report of the missed items or specific information or feedback on incorrect responses for why a particular answer is correct or incorrect. Once a candidate completes the self-assessment, they receive a performance profile, which displays the percentage of correct responses in the content areas that make up the examination content.

It is important to note that the results of the self-assessment exam do not guarantee or indicate individual success on the CCI exam, nor should the self-assessment serve as the only means for preparing for the CCI examination.

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