Free RCIS Cheat Sheet 2026: Exam Quick Reference

Pre-Procedural Activities

8%of exam

Room PreparationPatient AssessmentRecords and LabsTime-Out

Diagnostic Procedures

40%of exam

HemodynamicsCoronary AngiographyECG AnalysisImagingRadiation SafetyVascular Access

Interventional Procedures

34%of exam

Coronary InterventionStructural HeartPeripheral InterventionDevice ImplantsMechanical Support

Emergency Procedures and Protocols

13%of exam

Emergency PresentationsCoronary ComplicationsStructural ComplicationsEmergency Equipment

Post-Procedural Activities

5%of exam

HemostasisAccess ComplicationsPatient EducationTransfer of Care

Quick Facts

Credential: RCIS
Provider: CCI
Focus: Cardiac catheterization
Items: 170 total
Scored: 150
Unscored: 20 mixed throughout
Appointment: 3 hours
Question time: 2 hours 50 minutes
Pass: 650 on 0–900 scale
Fee: $365 USD
Delivery: Pearson VUE centers
ATT window: 90 days
Item styles: MCQ multi-response hotspot drag-place
Triennial CEUs: 36 total 30 cardiovascular

Time-Out Core

Patient Procedure Site Consent Allergies

Correct patientCorrect procedureCorrect siteConsent completeAllergies known

Eligibility and Renewal

Baseline education: High school diploma or GED
Pathway requirement: Meet one current pathway
RCIS235 education: Health-science program graduate
RCIS235 experience: One year full-time invasive work
RCIS235 procedures: 600 career procedures
RCIS4: Accredited invasive-program graduate
RCIS5 program: Nonaccredited one-year invasive program
RCIS5 clinical: 800 required clinical hours
Application proof: Typed supporting documentation
Processing: Minimum 15-20 business days
First renewal: Nine to twelve months
First renewal CEUs: None required
Later renewal: Every three years
Registry CEUs: 36 per triennial cycle
Cardiovascular CEUs: At least 30
Renewal ethics: Sign Code compliance
Current renewal fee: $165 USD

Pre-Procedure Readiness

Time-out: Patient procedure site agreement
Consent: Verify completion before procedure
Allergies: Contrast latex medications
Renal labs: Assess contrast-related risk
Coagulation labs: Assess bleeding status
Medications: Review anticoagulants and antiplatelets
Baseline rhythm: Document before intervention
Baseline pulses: Compare after access
Room setup: Equipment supplies medications ready
Sterile setup: Protect prepared field
Radiation setup: Shielding geometry dosimetry ready
Emergency readiness: Code equipment immediately available
Quality control: Verify equipment performance
Patient status: Validate current clinical condition

RA Wave Sequence

A contracts; C bulges; V fills

a contractionc valve bulgev venous fillingx relaxationy ventricular filling

FFR vs iFR

FFR

Maximal hyperemia
Pd divided by Pa

iFR

Resting wave-free period
No routine hyperemia

Both assess lesion physiology

Hemodynamic Clue Picker

Large RA v waves→Consider tricuspid regurgitation(Correlate clinically)
Large PCWP v waves→Consider mitral regurgitation(Confirm waveform quality)
LV-aortic systolic gradient→Assess aortic stenosis(Compare simultaneous pressures)
Oximetry saturation step-up→Locate left-to-right shunt(Repeat abnormal samples)
Diastolic pressures equalize→Consider tamponade(Check clinical instability)
Damped coronary pressure→Disengage and reassess(Avoid ostial obstruction)
Ringing pressure trace→Correct underdamping(Inspect tubing system)
Flattened pressure trace→Correct overdamping(Remove bubbles or clot)

Official Examination Matrix

Pre-procedure: 8%Domain A
Diagnostic: 40%Domain B
Interventional: 34%Domain C
Emergency: 13%Domain D
Post-procedure: 5%Domain E

ALARA Controls

Less time; more distance; use shielding

Minimize timeMaximize distanceUse shieldingCollimate field

IVUS vs OCT

IVUS

Ultrasound energy
Deeper tissue penetration

OCT

Near-infrared light
Higher surface resolution

Match depth versus detail

Diagnostic Modality Picker

Deep vessel wall detail→IVUS(Ultrasound penetration)
Fine stent surface detail→OCT(Blood clearing required)
Hyperemic lesion physiology→FFR(Compare Pd with Pa)
Resting lesion physiology→iFR(No routine hyperemia)
Intracardiac structural guidance→ICE(Catheter ultrasound)
Right-sided pressure assessment→Right heart cath(Include output oximetry)
Coronary lumen assessment→Angiography(Use orthogonal views)
Vascular access guidance→Ultrasound(See vessel and needle)

Coronary Anatomy

Left main: Branches into LAD LCx
LAD: Anterior wall and septum
Diagonal branches: Anterolateral left ventricle
Septal branches: Interventricular septum
LCx: Left atrioventricular groove
Obtuse marginals: Lateral left ventricle
RCA: Right and inferior territories
Acute marginals: Right ventricular branches
PDA: Defines coronary dominance
Posterolateral branches: Inferolateral ventricular supply
Right dominance: PDA arises from RCA
Left dominance: PDA arises from LCx

Dominance Definition

PDA origin defines coronary dominance

RCA means rightLCx means leftFind the PDA

Fick vs Thermodilution

Fick

Uses oxygen consumption
Uses oxygen content difference

Thermodilution

Uses temperature change
Uses indicator dilution curve

Both estimate cardiac output

Pressure Waveforms

RA a wave: Atrial contraction
RA c wave: Tricuspid valve bulging
RA v wave: Venous filling during systole
RA x descent: Atrial relaxation downward motion
RA y descent: Rapid ventricular filling
RV waveform: High systolic low diastolic
PA notch: Pulmonic valve closure
PCWP: Approximates left atrial pressure
LVEDP: Left ventricular filling pressure
Aortic notch: Aortic valve closure
Overdamping: Flattened waveform underestimated systolic
Underdamping: Ringing waveform exaggerated systolic
Zeroing: Open transducer to atmosphere
Leveling: Align transducer reference level

Radial vs Femoral Access

Radial

Wrist artery
Assess hand perfusion

Femoral

Groin artery
Retroperitoneal bleeding possible

Access choice changes complications

Hemodynamic Formulas

Cardiac output: CO = HR × SV
Cardiac index: CI = CO / BSA
Stroke volume: SV = CO / HR
Mean arterial pressure: MAP = (SBP + 2DBP) / 3
Systemic resistance: 80(MAP - RAP) / CO
Pulmonary resistance: 80(mPAP - PCWP) / CO
Fick output: VO2 / arterial-venous O2 difference
Resistance principle: Pressure gradient divided flow
FFR: Pd / Pa during hyperemia
iFR: Resting diastolic pressure ratio
Qp Qs above one: Left-to-right shunt pattern
Gorlin concept: Flow divided by square-root gradient

Diagnostic Modalities

Left heart cath: Coronaries LV aortic pressures
Right heart cath: Right pressures output oximetry
Coronary angiography: Displays contrast-filled lumen
LV angiography: Assesses motion and regurgitation
Twelve-lead ECG: Rhythm ischemia infarction conduction
IVUS: Ultrasound deep vessel imaging
OCT: Light high-resolution surface imaging
ICE: Intracardiac structural imaging
FFR: Hyperemic lesion physiology
iFR: Resting lesion physiology
Ultrasound access: Visualizes vessel and needle
Oximetry step-up: Suggests left-to-right shunt
TIMI zero: No antegrade flow
TIMI one: Penetration without distal perfusion
TIMI two: Partial delayed distal perfusion
TIMI three: Normal distal perfusion

Cath-Lab Pharmacology

Heparin: Potentiates antithrombin
Protamine: Reverses unfractionated heparin
Bivalirudin: Direct thrombin inhibitor
ACT: Tracks procedural anticoagulation
Aspirin: Irreversibly inhibits platelet COX-1
P2Y12 inhibitor: Blocks platelet ADP signaling
Nitroglycerin: Vasodilates coronary vessels
Adenosine: Creates hyperemia for FFR
Atropine: Treats symptomatic bradycardia
Epinephrine: Supports arrest or anaphylaxis
Norepinephrine: Vasopressor for hypotensive shock
Verapamil: Radial spasm prophylaxis option
Contrast: Visualizes vascular lumen
Thrombolytic: Promotes fibrin clot breakdown

Radiation and Sterile Safety

ALARA: Minimize necessary radiation exposure
Time: Shorter exposure lowers dose
Distance: Greater distance lowers exposure
Shielding: Blocks scattered radiation
Collimation: Narrows field and scatter
Detector position: Keep close to patient
Tube position: Keep farther from patient
Steep angulation: Usually increases radiation dose
Dosimeter: Tracks occupational exposure
Sterile field: Protect from contamination
Standard precautions: Treat blood as infectious
QA: Monitors overall process quality
QC: Tests equipment performance

BMS vs DES

BMS

Metal scaffold
No antiproliferative drug

DES

Drug-coated scaffold
Reduces neointimal growth

Both restore vessel patency

Coronary Intervention Tools

Guide catheter: Support and device delivery
Guidewire: Crosses and tracks lesion
Balloon angioplasty: Dilates stenotic segment
Bare-metal stent: Mechanical vessel scaffold
Drug-eluting stent: Drug limits neointimal growth
Atherectomy: Modifies resistant calcified plaque
Thrombectomy: Removes intravascular thrombus
Distal protection: Captures downstream embolic debris
IVUS optimization: Checks expansion and apposition
OCT optimization: Shows fine stent detail
CTO: Chronic total coronary occlusion
Closure device: Seals vascular access site

IABP vs Impella

IABP

Counterpulsation balloon
Inflates during diastole

Impella

Axial flow pump
Directly unloads ventricle

Know device flow mechanism

Structural Devices and Support

Pacemaker: Treats bradyarrhythmia electrically
ICD: Treats dangerous ventricular rhythms
CRT: Resynchronizes ventricular contraction
Loop recorder: Long-term rhythm monitoring
Temporary pacer: Short-term transvenous pacing
IABP: Diastolic inflation systolic deflation
Impella: Axial pump unloads ventricle
VA ECMO: Circulatory and oxygenation support
TAVR: Percutaneous aortic valve replacement
Valvuloplasty: Balloon dilates stenotic valve
TEER: Approximates mitral leaflets
LAA closure: Occludes left atrial appendage
Septal closure: Occludes intracardiac defect
Pericardiocentesis: Drains pericardial fluid
Peripheral angioplasty: Dilates peripheral stenosis

Diagnostic vs Interventional

Diagnostic

Measures and images
Forty percent weight

Interventional

Treats cardiovascular pathology
Thirty-four percent weight

Together dominate the matrix

Emergency Loop

Recognize Call Support Treat Reassess Document

Recognize changeCall teamSupport ABCsTreat protocolReassess response

Defibrillation vs Cardioversion

Defibrillation

Unsynchronized shock
VF or pulseless VT

Cardioversion

Synchronized shock
Unstable tachycardia with pulse

Pulse and rhythm determine mode

Emergency Response Picker

Ventricular fibrillation→Unsynchronized defibrillation(Follow resuscitation protocol)
Unstable tachycardia with pulse→Synchronized cardioversion(Follow ACLS pathway)
Symptomatic bradycardia→Atropine then pacing(Follow ACLS pathway)
Tamponade causes instability→Prepare pericardiocentesis(Escalate immediately)
Coronary perforation→Balloon tamponade support(Prepare covered stent)
No-reflow after intervention→Prepare intracoronary vasodilator(Follow operator direction)
Severe contrast anaphylaxis→Epinephrine airway support(Activate emergency response)
Coronary air embolus→Oxygen and aspiration(Prevent further injection)
Access site bleeding→Direct compression(Assess distal perfusion)
Device embolization→Prepare urgent retrieval(Surgical backup may follow)

Emergency Complications

Coronary perforation: May cause tamponade
Tamponade: Compression impairs cardiac filling
Coronary dissection: Intimal injury threatens flow
No-reflow: Poor microvascular perfusion
Air embolus: Air obstructs coronary flow
Ventricular fibrillation: Defibrillate immediately
Unstable tachycardia: Synchronized cardioversion indicated
Symptomatic bradycardia: Atropine or pacing pathway
Anaphylaxis: Epinephrine airway emergency
Stroke: Acute focal neurologic change
Pulmonary edema: Acute respiratory fluid overload
Cardiogenic shock: Pump failure causes hypoperfusion
Retroperitoneal hemorrhage: Occult bleeding after femoral access
Device migration: Embolization requires urgent response

Hematoma vs Pseudoaneurysm

Hematoma

Localized blood collection
Usually nonpulsatile

Pseudoaneurysm

Persistent arterial communication
Pulsatility or bruit

Pulsatility suggests arterial flow

Access Complication Picker

Localized spreading swelling→Suspect hematoma(Compress and reassess)
Pulsatile mass or bruit→Suspect pseudoaneurysm(Escalate for imaging)
Continuous bruit or thrill→Suspect AV fistula(Escalate for imaging)
Flank pain with hypotension→Suspect retroperitoneal bleeding(Emergency evaluation)
Cool pulseless distal limb→Suspect arterial occlusion(Urgent vascular response)
Forearm pain and tension→Suspect compartment syndrome(Urgent assessment)
Persistent access oozing→Apply direct pressure(Review anticoagulation)
Stable site and pulses→Continue scheduled monitoring(Document findings)

Post-Procedure Access Care

Patent hemostasis: Bleeding controlled flow preserved
Manual compression: Direct pressure achieves hemostasis
Hematoma: Localized blood collection
Pseudoaneurysm: Pulsatile extravascular sac
AV fistula: Artery-vein communication
Arterial occlusion: Reduced distal perfusion
Neurovascular checks: Pulse color warmth sensation
Access education: Bleeding restrictions warning signs
Transfer report: Procedure access medications complications
Contrast report: Communicate total contrast exposure
Hemostasis reassessment: Check bleeding and perfusion
Post-procedure symptoms: Escalate chest pain instability

Common Traps

Scaled Score Is Not Percent

Pass equals 650 scaled ≠ Raw equivalent not published

Unscored Items Look Identical

Twenty items are unscored ≠ Answer every item

Appointment Exceeds Question Time

Questions receive 170 minutes ≠ Tutorial plus survey share ten

PCWP Is Not PA Pressure

Wedge approximates left atrium ≠ Confirm true wedge tracing

Damping May Be Equipment

Inspect tubing and catheter ≠ Do not assume pathology

IVUS Is Not OCT

IVUS penetrates deeper ≠ OCT resolves finer detail

IABP Timing Is Phase-Specific

Inflate during diastole ≠ Deflate before systole

Shock Mode Depends Rhythm

VF needs unsynchronized shock ≠ Pulsed tachycardia needs synchronization

Access Complications Can Hide

Check pulses and vitals ≠ Flank pain signals bleeding

Last Minute

1.170 total; 150 scored
2.Twenty unscored items are mixed
3.Question time equals 170 minutes
4.Pass equals 650 scaled
5.Diagnostic domain equals 40%
6.Interventional domain equals 34%
7.PDA origin defines dominance
8.CO equals HR times SV
9.FFR uses maximal hyperemia
10.PCWP approximates left atrial pressure
11.Defibrillation is unsynchronized
12.Cardioversion synchronizes with R wave
13.IABP inflates during diastole
14.Recheck access site and pulses
15.First renewal needs no CEUs
16.Triennial renewal needs 36 CEUs

CCI RCIS Registered Cardiovascular Invasive Specialist

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