CCT Exam Flashcards

Q: What is the passing score on the CCI CCT exam?

The Certified Cardiographic Technician (CCT) exam requires a total scaled score of 650 on a 0-900 scale. The exam has 130 items (110 scored and 20 unscored pilot questions). Total testing time is 2 hours, with about 1 hour 50 minutes for questions and 10 minutes for a tutorial and survey.

Q: How is the CCT exam weighted by content area?

The current CCI examination matrix weights six duty areas: Performing Rhythm Analysis 40%, Analyzing 12-Lead ECG 22%, Performing Resting ECG 14%, Conducting Pre-Procedural Activities 10%, Performing Stress Tests 10%, and Performing Ambulatory Monitoring 4%. These 50 flashcards are distributed to match those weights.

Q: Does CCI publish a CCT pass rate?

CCI reports aggregate first-time pass rates for its credentials annually (across credentials these ranged roughly 56%-75% in 2025), but it does not prominently publish a fixed, per-credential CCT figure, so this set lists the CCT pass rate as not published. Confirm the current rate directly with CCI.

Q: What is the CCT retake / re-examination policy?

A candidate who does not pass must submit a new application with fees and observe a 45-day waiting period before testing again. CCI does not publish an escalating waiting period for additional failures, so the standard 45-day wait applies to each re-examination attempt. Verify current policy with CCI before reapplying.

Q: Do I need employer sponsorship to take the CCT exam?

No. CCI does not require employer sponsorship. Eligibility is established through one of three pathways (CCT1, CCT2, or CCT3) with a high school diploma/GED and supporting documentation of cardiovascular/allied health training, employment, or a science/physical-health degree.

Q: Which topics should I prioritize for the CCT exam?

Prioritize dysrhythmia recognition (Rhythm Analysis is 40% of the exam) and 12-lead interpretation - axis, hypertrophy, bundle branch blocks, and MI localization (22%) - plus resting ECG acquisition and lead placement (14%). Together these three areas make up about three-quarters of scored content.

Question 1

Normal sinus rhythm criteria

Accepted Answer

Rate 60-100 bpm, regular rhythm, an upright P wave before every QRS in lead II, a constant PR interval (0.12-0.20 s), and a narrow QRS (<0.12 s). The impulse originates in the SA node.

Question 2

Intrinsic pacemaker rates (SA vs AV vs Purkinje)

Accepted Answer

SA node fires 60-100 bpm (primary pacemaker). The AV junction escapes at 40-60 bpm, and the ventricular/Purkinje system escapes at 20-40 bpm. Lower sites take over only when higher pacemakers fail.

Question 3

Sinus bradycardia

Accepted Answer

A sinus rhythm with all normal features except a rate below 60 bpm. Can be normal in athletes or during sleep; pathologic causes include increased vagal tone, beta-blockers, and inferior MI.

Question 4

Sinus tachycardia

Accepted Answer

A sinus rhythm with a rate above 100 bpm (typically 100-150). P waves precede each QRS but may blend into the preceding T wave. Usually a response to fever, pain, exertion, hypovolemia, or anxiety - not a primary arrhythmia.

Question 5

Rate calculation - 300 method (large-box)

Accepted Answer

Divide 300 by the number of large (5 mm) boxes between two consecutive R waves. Memorize the sequence 300-150-100-75-60-50. Best for regular rhythms.

Question 6

Rate calculation - 1500 and 6-second methods

Accepted Answer

1500 method: divide 1500 by the number of small (1 mm) boxes between R waves - precise for regular rhythms. 6-second method: count QRS complexes in a 6-second strip and multiply by 10 - best for irregular rhythms.

Question 7

PR interval - normal range and meaning

Accepted Answer

Measured from the start of the P wave to the start of the QRS; normal is 0.12-0.20 s (3-5 small boxes). It represents atrial depolarization plus the AV node delay. A PR >0.20 s indicates first-degree AV block.

Question 8

Atrial fibrillation

Accepted Answer

Irregularly irregular rhythm with no discernible P waves - only chaotic fibrillatory (f) waves. Atrial rate is 350-600 with a variable ventricular response. Main risk: atrial thrombus formation leading to embolic stroke.

Question 9

Atrial flutter

Accepted Answer

Regular sawtooth flutter (F) waves at an atrial rate of 250-350 bpm (classically ~300). The AV node conducts in ratios (often 2:1), so a 300 atrial rate commonly gives a ventricular rate near 150.

Question 10

Premature atrial contraction (PAC)

Accepted Answer

An early beat from an ectopic atrial focus with an abnormally shaped P wave and a normal, narrow QRS. It is usually followed by a non-compensatory (incomplete) pause because it resets the SA node.

Question 11

Premature ventricular contraction (PVC)

Accepted Answer

An early, wide (>0.12 s), bizarre QRS with no preceding P wave and a T wave in the opposite direction. It is typically followed by a full compensatory pause. Three or more in a row is ventricular tachycardia.

Question 12

Paroxysmal supraventricular tachycardia (PSVT/SVT)

Accepted Answer

A regular narrow-complex tachycardia at 150-250 bpm with sudden onset and termination. P waves are often buried in the preceding T wave or not visible because the rate is so fast.

Question 13

Junctional rhythm

Accepted Answer

Originates in the AV junction at 40-60 bpm. P waves are inverted (retrograde) and may appear just before, during (hidden), or after the narrow QRS. Accelerated junctional is 60-100; junctional tachycardia is >100.

Question 14

First-degree AV block

Accepted Answer

Every atrial impulse conducts, but the PR interval is prolonged beyond 0.20 s and stays constant beat to beat. No QRS complexes are dropped. It is generally benign.

Question 15

Second-degree AV block, Mobitz I (Wenckebach)

Accepted Answer

The PR interval lengthens progressively over successive beats until one P wave fails to conduct and a QRS is dropped, producing grouped beating. The cycle then repeats. Usually a benign AV-nodal block.

Question 16

Second-degree AV block, Mobitz II

Accepted Answer

The PR interval stays constant, then a P wave suddenly fails to conduct and a QRS is dropped without any PR change. More dangerous than Mobitz I because it can progress to complete heart block; often needs a pacemaker.

Question 17

Third-degree (complete) AV block

Accepted Answer

Complete AV dissociation: atria and ventricles beat independently, so P waves and QRS complexes have no relationship and the atrial rate exceeds the ventricular rate. A junctional (40-60) or ventricular (20-40) escape rhythm sustains output.

Question 18

Ventricular tachycardia (VT)

Accepted Answer

Three or more consecutive PVCs; a regular wide-complex (>0.12 s) tachycardia at 100-250 bpm with no normal P waves. May be pulseless. Sustained VT is a medical emergency that can deteriorate into ventricular fibrillation.

Question 19

Ventricular fibrillation (VF)

Accepted Answer

Chaotic, disorganized electrical activity with no identifiable P waves, QRS complexes, or T waves and no effective cardiac output. It is a lethal rhythm requiring immediate defibrillation and CPR.

Question 20

Asystole

Accepted Answer

Absence of all ventricular electrical activity - a flat line. Confirm in two or more leads to rule out fine VF or a disconnected lead. Asystole is NOT shockable; treatment is high-quality CPR and epinephrine.

Question 21

Frontal-plane axis - quadrant (I and aVF) method

Accepted Answer

Use the net QRS in leads I and aVF. Both positive = normal axis. Lead I positive, aVF negative = possible left axis deviation (check lead II). Lead I negative, aVF positive = right axis deviation. Both negative = extreme (northwest) axis.

Question 22

Left axis deviation (LAD)

Accepted Answer

A mean QRS axis between -30 and -90 degrees. Lead I is positive and lead II is negative. Common causes: left anterior fascicular block, left ventricular hypertrophy, inferior MI, and some conduction abnormalities.

Question 23

Right axis deviation (RAD)

Accepted Answer

A mean QRS axis between +90 and +180 degrees. Lead I is negative and aVF is positive. Common causes: right ventricular hypertrophy, left posterior fascicular block, acute pulmonary embolism, and lateral MI.

Question 24

Ischemia vs injury vs infarction on ECG

Accepted Answer

Ischemia = ST-segment depression and/or T-wave inversion (reversible). Injury = ST-segment elevation (acute, ongoing). Infarction/necrosis = pathologic Q waves (established tissue death). They can appear together as an MI evolves.

Question 25

Left ventricular hypertrophy - Sokolow-Lyon criteria

Accepted Answer

LVH is suggested when the S wave in V1 plus the R wave in V5 or V6 is 35 mm (3.5 mV) or greater. An R wave in aVL of 11 mm or more is another supportive sign. Often accompanied by ST-T strain.

Question 26

Right bundle branch block (RBBB)

Accepted Answer

QRS 0.12 s or wider with an rSR' ('rabbit ears') pattern in V1-V2 and a wide, slurred S wave in leads I and V6. The right ventricle depolarizes late.

Question 27

Left bundle branch block (LBBB)

Accepted Answer

QRS 0.12 s or wider with a broad, notched (monophasic) R wave in leads I, aVL, V5-V6, a deep S in V1, and absent septal Q waves. New LBBB with ischemic symptoms is treated as a possible acute MI.

Question 28

Inferior MI - leads and artery

Accepted Answer

ST elevation in leads II, III, and aVF indicates an inferior-wall MI, most often from occlusion of the right coronary artery (RCA). Watch for accompanying bradycardia and heart block.

Question 29

Anteroseptal / anterior MI - leads and artery

Accepted Answer

Septal changes appear in V1-V2 and anterior changes in V3-V4; together V1-V4 point to an anteroseptal MI from the left anterior descending (LAD) artery. Large anterior MIs carry a high risk of heart failure.

Question 30

Lateral MI - leads and artery

Accepted Answer

ST changes in leads I, aVL, V5, and V6 indicate a lateral-wall MI, usually from the left circumflex (LCx) artery. V5-V6 are the low-lateral leads; I and aVL are the high-lateral leads.

Question 31

Posterior MI - ECG clues

Accepted Answer

There are no standard posterior leads, so look for reciprocal changes in V1-V2: tall broad R waves with ST-segment depression (a mirror image of elevation). Confirm with posterior leads V7-V9 showing ST elevation; usually RCA or LCx.

Question 32

Precordial (chest) lead placement V1-V6

Accepted Answer

V1: 4th ICS right sternal border. V2: 4th ICS left sternal border. V3: midway between V2 and V4. V4: 5th ICS midclavicular line. V5: 5th ICS anterior axillary line (level with V4). V6: 5th ICS midaxillary line.

Question 33

Limb electrode placement and color code (AHA)

Accepted Answer

Place electrodes on the four limbs: RA = white, LA = black, LL = red, RL = green (ground). Mnemonics: 'white on right,' 'smoke (black) over fire (red)' on the left, 'snow over grass' on the right.

Question 34

Standard ECG paper and calibration

Accepted Answer

Standard speed is 25 mm/s. One small (1 mm) box = 0.04 s and one large (5 mm) box = 0.20 s horizontally. Standard calibration is 10 mm = 1 mV, verified by a rectangular standardization mark before recording.

Question 35

QRS duration - normal value

Accepted Answer

The QRS represents ventricular depolarization and is normally under 0.12 s (typically 0.06-0.10 s). A QRS of 0.12 s or wider suggests a bundle branch block, a ventricular rhythm, or an aberrantly conducted beat.

Question 36

QT interval and QTc

Accepted Answer

The QT spans ventricular depolarization and repolarization and shortens as heart rate rises, so it is rate-corrected (QTc, e.g., Bazett). A prolonged QTc (>0.44 s in men, >0.46 s in women) raises the risk of torsades de pointes.

Question 37

Modified leads - posterior and right-sided

Accepted Answer

For a suspected posterior MI, add posterior leads V7-V9 across the back. For suspected right-ventricular involvement (often with inferior MI), add right-sided leads, especially V4R, by mirroring V4 to the right chest.

Question 38

Common ECG artifacts

Accepted Answer

Wandering baseline = slow drift from movement, respiration, or loose/dried electrodes. Somatic (muscle) tremor = fuzzy, irregular baseline from muscle activity or shivering. AC (60-Hz) interference = uniform fine spikes from nearby electrical equipment or poor grounding.

Question 39

Two-identifier patient verification

Accepted Answer

Before any ECG, confirm the patient's identity with two identifiers (such as full name and date of birth), verify the physician's order, and enter demographics accurately so the tracing is matched to the correct record.

Question 40

Skin preparation for electrode adhesion

Accepted Answer

Clean the skin, let it dry, and lightly abrade the outer layer to lower impedance. Clip (do not shave) excess hair, and remove lotion, oils, or sweat. Poor prep is a leading cause of artifact and loose leads.

Question 41

Sternal angle (angle of Louis) landmark

Accepted Answer

The angle of Louis is the ridge where the manubrium meets the sternal body, level with the 2nd costal cartilage/2nd rib. Find the 2nd intercostal space there, then count down to the 4th ICS to place V1 and V2 accurately.

Question 42

Pre-recording equipment and standardization check

Accepted Answer

Before acquisition, confirm the machine is set to 25 mm/s and 10 mm/mV, verify the standardization mark, and check that all lead wires are securely attached. This prevents distorted amplitudes and missing leads.

Question 43

Limb lead reversal (RA/LA)

Accepted Answer

Switching the right- and left-arm electrodes inverts lead I (negative P wave and QRS in I) and swaps aVR/aVL, which can mimic dextrocardia. Recognizing this lets the technician correct placement rather than misreport pathology.

Question 44

Stress test target heart rate

Accepted Answer

The diagnostic target is 85% of the age-predicted maximum: Target HR = 0.85 x (220 - age). For a 50-year-old, max HR = 170 and target = ~145 bpm. Reaching 85% indicates an adequate diagnostic stress.

Question 45

Bruce protocol

Accepted Answer

The standard Bruce treadmill protocol uses 3-minute stages that increase BOTH speed and grade at each stage (Stage 1: 1.7 mph / 10%). It is the most common exercise stress protocol for reasonably fit patients.

Question 46

Modified Bruce and Naughton protocols

Accepted Answer

Modified Bruce adds two easier warm-up stages (1.7 mph at 0%, then 5%) before standard Bruce. The Naughton protocol keeps a low constant speed and raises the grade in small steps (~1 MET each) - both suit deconditioned or cardiac patients.

Question 47

Stress test termination indicators

Accepted Answer

Stop the test for ST elevation >1 mm in leads without Q waves, a drop in systolic BP of 10 mmHg or more with ischemia, moderate-to-severe angina, sustained ventricular tachycardia, CNS symptoms (dizziness, near-syncope), or the patient's request.

Question 48

Pharmacologic stress agents

Accepted Answer

For patients who cannot exercise, dobutamine raises myocardial oxygen demand (like exercise), while vasodilators - adenosine, regadenoson, or dipyridamole - dilate coronary arteries to reveal perfusion differences during nuclear imaging.

Question 49

Holter monitor

Accepted Answer

A Holter records the ECG continuously for 24-48 hours (extended devices last up to ~14 days). The patient keeps a symptom diary so recorded events can be correlated with activity and symptoms.

Question 50

Event recorder vs loop recorder

Accepted Answer

A post-event recorder is activated by the patient when symptoms occur. A loop recorder continuously overwrites a memory loop and, when triggered, saves the ECG from just before and after the event - capturing brief, infrequent arrhythmias a Holter may miss.

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