Certified Cardiographic Technician (CCT) Practice Test
The Certified Cardiographic Technician (CCT) is best obtained by individuals working in the areas of ECG (electrocardiogram), Holter monitoring, and stress testing. There are four different CCTs available. Regardless of the certification being applied for, all applicants must hold a high school diploma or the GED (General Education Development) equivalent at the time of their application. Varying application requirements of the four different types of CCTs are as follows:
1. The CCT1 examination requires the applicant to be a current student or a graduate of a cardiovascular or allied health training program. To support this standing, the student must be able to submit a program completion certificate and/or educational transcripts, or a student verification letter.
2. The CCT2 examination requires candidates to be currently or previously employed in the field of cardiovascular technology, or in an allied health field that is recognized by the American Medical Association (AMA). Submittal of an employment verification letter is required.
3. The CCT3 examination requires candidates to have obtained a graduate degree or an undergraduate degree from an accredited institution in a field related to science or physical health. Prior to taking the examination, candidates must submit a completion certificate and/or student transcripts, or a student verification letter.
4. The CCT4 examination requires the applicant to have completed at least two years of volunteer service in the field of cardiovascular technology, and be able to provide documentation supporting full-time technical activities for those two years. An employment verification letter is required.
The following is a list of topics that can be expected on any of the four CCT examinations:
• Basic cardiovascular anatomy and physiology: 14 percent
There will be questions concerning the heart, circulation of the heart, coronary circulation, physiology, and anatomical terms.
ECG (electrocardiogram) techniques and recognition: 32 percent
The applicant will be required to define, identify, measure, explain, and analyze waveforms and ECG measurements. There will also be questions on ECG leads, as well as ECG, Holter, and stress testing instrumentation. The applicant must be able to recognize recording errors and recording artifacts, as well as patient and electrical safety hazards. Finally, the applicant must distinguish, interpret, and describe cardiac arrhythmias.
• Stress test techniques, indicators, and contraindicators: 11 percent
Expect to see questions related to stress testing, the interpretation of the exercise, ECG, ergometers, and pharmacologic factors.
• Ambulatory or Holter monitoring: 20 percent
The applicant must have a strong understanding of indications, contraindications, preparation techniques, lead placement and procedures, and interpretation of the monitoring results.
• Basic cardiovascular electrophysiology: 16 percent
This section covers conduction systems, refractory issues, transmembrane potential, and action potential.
• Cardiac medications and indications: 7 percent
The applicant must fully understand the categories of medications and indications that a patient may require.
General areas of knowledge that can be expected on the CCT examination include, but are not limited to, the following:
- Cardiac valve function
- ECG calibration methods
- Single and 3-channel ECGs
- Relationship of cardiac output to heart rate and stroke volume
- Troubleshooting ECGs
- Cardiac cycle
- ECG measurement
- Blood flow
- Somatic tremor
- Electrical interference
CCT Practice Questions
1. Which of the following is the correct sequence by which action potentials are conducted through the heart?
A. SA node -> AV node -> bundle branches -> Purkinje fibers
B. Bundle branches -> Purkinje fibers -> SA node -> AV node
C. Purkinje fibers -> SA node -> bundle branches -> AV node
D. AV node -> SA node -> bundle branches -> Purkinje fibers
2. What type of heart block is seen in the following electrocardiogram (ECG) strip?
A. First-degree heart block
B. Second-degree heart block, type 1
C. Second-degree heart block, type 2
D. Third-degree heart block
3. When the ECG below was performed, what was done incorrectly by the ECG technician?
A. The machine was not calibrated correctly
B. The paper in the machine was placed upside down
C. The placement of the leads was reversed
D. The precordial leads and limb leads were intermixed
4. Which of the following would be LEAST likely to complicate the diagnosis of myocardial ischemia based on Holter monitor tracings?
A. If the patient has atrial fibrillation
B. If the patient has a left bundle branch block
C. If the patient is on digoxin
D. If the patient is on a beta-blocker
5. Which of the following is the correct sequence for cardiac blood flow?
A. Vena cava -> left atrium -> mitral valve -> left ventricle -> pulmonary valve-> pulmonary artery -> lungs -> pulmonary vein -> right atrium -> tricuspid valve -> right ventricle -> aortic valve -> aorta
B. Vena cava -> right atrium -> mitral valve -> right ventricle -> pulmonary valve -> pulmonary artery -> lungs -> pulmonary vein -> left atrium -> tricuspid valve-> left ventricle -> aortic valve -> aorta
C. Vena cava -> right atrium -> tricuspid valve -> right ventricle -> pulmonary valve -> pulmonary artery -> lungs -> pulmonary vein -> left atrium -> mitral valve-> left ventricle -> aortic valve -> aorta
D. Vena cava -> left atrium -> mitral valve -> left ventricle -> aortic valve -> right atrium -> tricuspid valve -> right ventricle -> pulmonary valve-> pulmonary artery -> lungs
1. A: The sequence by which an action potential is conducted through the heart is from the sinoatrial (SA) node to the atrioventricular (AV) node to the bundle branches and then to the Purkinje fibers.
2. B: The pictured ECG is a second-degree heart block, type 1. This rhythm is also called Mobitz I or Wenckebach. With this heart block the PR interval gets longer with each beat until eventually a P wave occurs, but a QRS does not follow (a beat is skipped). After the skipped beat, the pattern starts over again. A first-degree heart block occurs when the PR interval is longer than 0.2 seconds, but the PR interval generally remains constant and the QRS is not dropped. A second-degree heart block, type 2, also called Mobitz II, is apparent when the QRS suddenly fails to show up after a P wave. A fairly consistent ratio of P waves to QRS complexes is common, and this rhythm lacks the increasing PR interval that is seen in the Mobitz I block. A third-degree heart block is also called a complete heart block and the atria and ventricles beat independently of one another.
3. C: This patient has a normal rate and rhythm, but the appearance of the ECG is abnormal because the leads have been reversed. Reversal of lead placement has led to an ECG strip with negative (inverted) P waves, QRS complexes, and T waves. This is a common mistake when placing ECG leads and can lead to confusion when reading the ECG.
4. D: It can be very difficult to accurately diagnose myocardial ischemia on a Holter tracing if the patient has certain medical conditions or is on certain medications. Medical conditions that would interfere with the diagnosis include atrial fibrillation, atrial flutter, left bundle branch block, preexcitation, and serious ionic disorders. Medications that may interfere with diagnosis include digoxin, amiodarone, flecainide, antidepressants, and diuretics. In these cases it is not advisable to give a diagnosis of myocardial ischemia based on Holter tracing findings. Beta-blockers are unlikely to interfere with diagnosing myocardial ischemia on the Holter tracing.
5. C: Deoxygenated blood from the body is carried to the right atrium by the vena cava. It is then pumped to the lungs by the right ventricle, where it becomes oxygenated, and then returned to the left atrium. Oxygenated blood moves from the left atrium to the left ventricle and is then pumped to the body through the aorta.