CCRP AACVPR 2026 EXAM SCRIPT QUESTIONS AND
ANSWERS RATED A+
✔✔Reassessment recommendations of lipid profile repeating - ✔✔repeat in 4-12 weeks
after initiation of statin therapy and 3-12 months periodically thereafter to access for the
expected response to therapy
✔✔Four clinical groups that benefit from statin therapy - ✔✔-Clinical ASCVD
-LDL-C ≥190
-Diabetes, aged 40-75, LDL 70-189 and no clinical ASCVD
-Aged 45-70, LDL 70-189, no diabetes or clinical ASCVD and 10 year risk for ASCVD
≥7.5%
✔✔Intensity of statin recommended for groups with Clinical ASCVD - ✔✔High intensity
for those ≤75
Moderate intensity for those >75
✔✔Intensity of statin recommended for groups with LDL ≥190 - ✔✔High intensity
✔✔Intensity of statin recommended for groups with Diabetes, aged 40-75, LDL 70-189
and no clinical ASCVD - ✔✔Moderate intensity
*If 10 year risk ≥7.5%, option use of high intensity
✔✔Intensity of statin recommended for groups with Ages 45-70, LDL 70-189, no DM, or
clinical ASCVD and 10 year risk for ASCVD ≥7.5% - ✔✔Moderate to high intensity
✔✔Clinical ASCVD - ✔✔- acute coronary syndrome
- history of MI
- stable or unstable angina
- coronary or other arterial revascularization
- stroke/TIA
- peripheral artery disease
✔✔Two most common reasons the result in non-adherance to statin therapy -
✔✔Muscle side effects and transaminitis
✔✔Lipid effects of Niacin - ✔✔flushing, transaminitis, hyperglycemia, hyperuricemia
✔✔Lipid effects of bile acid sequestrates - ✔✔hypertriglycermia
✔✔Lipid effects of cholesterol absorption inhibitors - ✔✔transaminitis
✔✔Lipid effects of vibrates - ✔✔myopathy, renal dysfunction
,✔✔Lipid effects of omega 3 ftty acids - ✔✔DI disturbances, skin changes, bleeding
✔✔Transaminitis - ✔✔having high levels of certain liver enzymes called transaminases.
✔✔Myalgias - ✔✔muscle pain
✔✔Rhabdomyolysis - ✔✔-condition in which damaged skeletal muscle breaks down
rapidly (caused by trauma, extreme exertion, or drug toxicity; in severe cases renal
failure can result)
-death of muscle fibers and release of their contents into the bloodstream.
✔✔What type of contraindication: Recent changes in ECG - ✔✔absolute
✔✔What type of contraindication: unstable angina - ✔✔absolute
✔✔What type of contraindication: uncontrolled cardiac arrhythmias - ✔✔absolute
✔✔What type of contraindication: symptomatic severe aortic stenosis or other valvular
disease - ✔✔absolute
✔✔What type of contraindication: decompensated symptomatic heart failure -
✔✔absolute
✔✔What type of contraindication: acute PE or pulmonary infarction - ✔✔absolute
✔✔What type of contraindication: acute non cardiac disorder that may affect exercise
performance or may be aggravated by exercise (infection,thyrotoxisosis) - ✔✔absolute
✔✔What type of contraindication: acute myocarditis or pericarditis - ✔✔absolute
✔✔What type of contraindication: acute thrombophlebitis - ✔✔absolute
✔✔What type of contraindication: physical disability that would preclude safe and
adequate exercise performance - ✔✔absolute
✔✔What type of contraindication: electrolyte abnormalities - ✔✔relative
✔✔What type of contraindication: tachyarrhythmias or bradyarrhythmias - ✔✔relative
✔✔What type of contraindication: high degree atrioventricular block - ✔✔relative
✔✔What type of contraindication: atrial fibrillation with uncontrolled rate - ✔✔relative
,✔✔What type of contraindication: hypertrophic obstructive cardiomyopathy with peak
resting left ventricular outflow gradient of >25mmHg - ✔✔relative
✔✔What type of contraindication: known aortic dissection - ✔✔relative
✔✔What type of contraindication: severe resting arterial HTN (SBP >200 and DBP
>100) - ✔✔relative
✔✔What type of contraindication: mental impairments leading to inability to cooperate
with testing - ✔✔relative
✔✔Adverse réponse to inpatient exercise leading to exercise discontinuation - ✔✔-DBP
≥110 mmHg
-Decreased SP >10mg
-Significant ventricular or atrial dysrhythmias
-second or third degree heart block
-s/s of exercise intolerance including angina, dyspnea, EKG changes suggestive of
ischemia
✔✔P wave normal response to exercise - ✔✔minor and insignificant changes in
morphology
✔✔P and T wave of successive beats normal response to exercise -
✔✔superimposition
✔✔Septal Q wave amplitudes normal response to exercise - ✔✔increases
✔✔R wave amplitudes normal response to exercise - ✔✔slightly decreases
✔✔T wave amplitude normal response to exercise - ✔✔increases
✔✔QRS duration normal response to exercise - ✔✔minimal shortening
✔✔J point normal response to exercise - ✔✔depression
✔✔QT interval normal response to exercise - ✔✔rate related shortening
✔✔ST segments may be affected by - ✔✔resting ECG configuration (BBB, LVH) and
pharmacological agents
✔✔Depression of J point that leads to marked ST segment up sloping is due to -
✔✔competition between normal depolarization and delayed terminal depolarization
faces rather than to ischemia
, ✔✔Exercise induced myocardial ischemia may be manifested by three different types of
ST segment changes in ECG - ✔✔-ST segment elevation
-ST segment depression
-ST segment normalization or absence of change
✔✔ST segment elevation represents (electric conductivity) - ✔✔early depolarization
✔✔If ST segment is seen in normal ECG, increase HR may cause - ✔✔elevated ST
segment to return to isoelectric baseline
✔✔Exercise induced ST-segment elevation in leads displaying a previous Q wave
infarction may be indicative of - ✔✔wall motion abnormalities or ventricular aneurysm
✔✔Exercise induced ST segment elevation on a normal EKG (except aVR or V1-V2)
indicates - ✔✔significant myocardial ischemia and localizes the ischemia to a specific
area of the myocardium
✔✔ST segment elevation indicates myocardial injury when followed by - ✔✔the
evolution of significant Q-waves
✔✔St segment depression criteria - ✔✔depression of the j point and the slope at 80 sec
past the J point
✔✔St segment depression is the most common manifestation of - ✔✔exercise-induced
myocardial ischemia
✔✔Horizontal or downsloping St segment depression is more indicative of -
✔✔myocardial ischemia than is up-sloping depression
✔✔The standard criteria of a positive stress test is (St segment depression) - ✔✔≥1mm
of horizontal or down sloping ST segment 80msec after the J point
✔✔slowly up-sloping St segment depression should be considered - ✔✔a borderline
response
✔✔St segment depression does not localize - ✔✔ischemia to a specific area of
myocardium
✔✔The more leads with apparent ischemic ST segment shifts, - ✔✔the more sever the
disease
✔✔St segment depression occurring only in recovery likely represents - ✔✔a true
positive response and should be considered an important diagnostic finding
ANSWERS RATED A+
✔✔Reassessment recommendations of lipid profile repeating - ✔✔repeat in 4-12 weeks
after initiation of statin therapy and 3-12 months periodically thereafter to access for the
expected response to therapy
✔✔Four clinical groups that benefit from statin therapy - ✔✔-Clinical ASCVD
-LDL-C ≥190
-Diabetes, aged 40-75, LDL 70-189 and no clinical ASCVD
-Aged 45-70, LDL 70-189, no diabetes or clinical ASCVD and 10 year risk for ASCVD
≥7.5%
✔✔Intensity of statin recommended for groups with Clinical ASCVD - ✔✔High intensity
for those ≤75
Moderate intensity for those >75
✔✔Intensity of statin recommended for groups with LDL ≥190 - ✔✔High intensity
✔✔Intensity of statin recommended for groups with Diabetes, aged 40-75, LDL 70-189
and no clinical ASCVD - ✔✔Moderate intensity
*If 10 year risk ≥7.5%, option use of high intensity
✔✔Intensity of statin recommended for groups with Ages 45-70, LDL 70-189, no DM, or
clinical ASCVD and 10 year risk for ASCVD ≥7.5% - ✔✔Moderate to high intensity
✔✔Clinical ASCVD - ✔✔- acute coronary syndrome
- history of MI
- stable or unstable angina
- coronary or other arterial revascularization
- stroke/TIA
- peripheral artery disease
✔✔Two most common reasons the result in non-adherance to statin therapy -
✔✔Muscle side effects and transaminitis
✔✔Lipid effects of Niacin - ✔✔flushing, transaminitis, hyperglycemia, hyperuricemia
✔✔Lipid effects of bile acid sequestrates - ✔✔hypertriglycermia
✔✔Lipid effects of cholesterol absorption inhibitors - ✔✔transaminitis
✔✔Lipid effects of vibrates - ✔✔myopathy, renal dysfunction
,✔✔Lipid effects of omega 3 ftty acids - ✔✔DI disturbances, skin changes, bleeding
✔✔Transaminitis - ✔✔having high levels of certain liver enzymes called transaminases.
✔✔Myalgias - ✔✔muscle pain
✔✔Rhabdomyolysis - ✔✔-condition in which damaged skeletal muscle breaks down
rapidly (caused by trauma, extreme exertion, or drug toxicity; in severe cases renal
failure can result)
-death of muscle fibers and release of their contents into the bloodstream.
✔✔What type of contraindication: Recent changes in ECG - ✔✔absolute
✔✔What type of contraindication: unstable angina - ✔✔absolute
✔✔What type of contraindication: uncontrolled cardiac arrhythmias - ✔✔absolute
✔✔What type of contraindication: symptomatic severe aortic stenosis or other valvular
disease - ✔✔absolute
✔✔What type of contraindication: decompensated symptomatic heart failure -
✔✔absolute
✔✔What type of contraindication: acute PE or pulmonary infarction - ✔✔absolute
✔✔What type of contraindication: acute non cardiac disorder that may affect exercise
performance or may be aggravated by exercise (infection,thyrotoxisosis) - ✔✔absolute
✔✔What type of contraindication: acute myocarditis or pericarditis - ✔✔absolute
✔✔What type of contraindication: acute thrombophlebitis - ✔✔absolute
✔✔What type of contraindication: physical disability that would preclude safe and
adequate exercise performance - ✔✔absolute
✔✔What type of contraindication: electrolyte abnormalities - ✔✔relative
✔✔What type of contraindication: tachyarrhythmias or bradyarrhythmias - ✔✔relative
✔✔What type of contraindication: high degree atrioventricular block - ✔✔relative
✔✔What type of contraindication: atrial fibrillation with uncontrolled rate - ✔✔relative
,✔✔What type of contraindication: hypertrophic obstructive cardiomyopathy with peak
resting left ventricular outflow gradient of >25mmHg - ✔✔relative
✔✔What type of contraindication: known aortic dissection - ✔✔relative
✔✔What type of contraindication: severe resting arterial HTN (SBP >200 and DBP
>100) - ✔✔relative
✔✔What type of contraindication: mental impairments leading to inability to cooperate
with testing - ✔✔relative
✔✔Adverse réponse to inpatient exercise leading to exercise discontinuation - ✔✔-DBP
≥110 mmHg
-Decreased SP >10mg
-Significant ventricular or atrial dysrhythmias
-second or third degree heart block
-s/s of exercise intolerance including angina, dyspnea, EKG changes suggestive of
ischemia
✔✔P wave normal response to exercise - ✔✔minor and insignificant changes in
morphology
✔✔P and T wave of successive beats normal response to exercise -
✔✔superimposition
✔✔Septal Q wave amplitudes normal response to exercise - ✔✔increases
✔✔R wave amplitudes normal response to exercise - ✔✔slightly decreases
✔✔T wave amplitude normal response to exercise - ✔✔increases
✔✔QRS duration normal response to exercise - ✔✔minimal shortening
✔✔J point normal response to exercise - ✔✔depression
✔✔QT interval normal response to exercise - ✔✔rate related shortening
✔✔ST segments may be affected by - ✔✔resting ECG configuration (BBB, LVH) and
pharmacological agents
✔✔Depression of J point that leads to marked ST segment up sloping is due to -
✔✔competition between normal depolarization and delayed terminal depolarization
faces rather than to ischemia
, ✔✔Exercise induced myocardial ischemia may be manifested by three different types of
ST segment changes in ECG - ✔✔-ST segment elevation
-ST segment depression
-ST segment normalization or absence of change
✔✔ST segment elevation represents (electric conductivity) - ✔✔early depolarization
✔✔If ST segment is seen in normal ECG, increase HR may cause - ✔✔elevated ST
segment to return to isoelectric baseline
✔✔Exercise induced ST-segment elevation in leads displaying a previous Q wave
infarction may be indicative of - ✔✔wall motion abnormalities or ventricular aneurysm
✔✔Exercise induced ST segment elevation on a normal EKG (except aVR or V1-V2)
indicates - ✔✔significant myocardial ischemia and localizes the ischemia to a specific
area of the myocardium
✔✔ST segment elevation indicates myocardial injury when followed by - ✔✔the
evolution of significant Q-waves
✔✔St segment depression criteria - ✔✔depression of the j point and the slope at 80 sec
past the J point
✔✔St segment depression is the most common manifestation of - ✔✔exercise-induced
myocardial ischemia
✔✔Horizontal or downsloping St segment depression is more indicative of -
✔✔myocardial ischemia than is up-sloping depression
✔✔The standard criteria of a positive stress test is (St segment depression) - ✔✔≥1mm
of horizontal or down sloping ST segment 80msec after the J point
✔✔slowly up-sloping St segment depression should be considered - ✔✔a borderline
response
✔✔St segment depression does not localize - ✔✔ischemia to a specific area of
myocardium
✔✔The more leads with apparent ischemic ST segment shifts, - ✔✔the more sever the
disease
✔✔St segment depression occurring only in recovery likely represents - ✔✔a true
positive response and should be considered an important diagnostic finding
