CCI Registry Self-Assessment Examination
– Cardiovascular Credentialing
International (2026 Edition) Study Guide
and Practice Questions
Cardiovascular Anatomy & Physiology
Q1: The left anterior descending (LAD) coronary artery supplies which of the
following myocardial territories?
A. Inferior wall and right ventricle
B. Lateral wall and posterior wall
C. Anterior wall, anteroseptal wall, and apex
D. Right atrium and sinoatrial node in 60% of patients
Correct Answer: C
Rationale: The LAD artery courses down the anterior interventricular groove and
supplies the anterior left ventricular wall, the anterior two-thirds of the
interventricular septum, and the apex. The RCA supplies the inferior wall and SA
node in most patients (Answer D), while the LCx supplies the lateral and posterior
walls (Answer B).
Q2: During the cardiac cycle, which valve closes immediately following the onset
of ventricular systole, producing the first heart sound (S1)?
A. Aortic valve
B. Pulmonic valve
C. Mitral and tricuspid valves
D. Mitral valve only
Correct Answer: C
Rationale: S1 is produced by closure of the atrioventricular (AV) valves—the
mitral and tricuspid valves—at the beginning of ventricular systole when
ventricular pressure exceeds atrial pressure. The aortic and pulmonic valves
close during ventricular diastole, producing S2.
,Q3: A patient has the following right heart catheterization pressures: RA 12
mmHg, RV 45/12 mmHg, PA 45/25 mmHg, PAWP 18 mmHg. Which hemodynamic
parameter is most consistent with these findings?
A. Normal right-sided pressures
B. Pulmonary hypertension with elevated left atrial pressure
C. Tricuspid regurgitation with normal pulmonary pressures
D. Pulmonary stenosis with right ventricular failure
Correct Answer: B
Rationale: The elevated PAWP (18 mmHg; normal 4–12 mmHg) indicates elevated
left atrial pressure, while the elevated PA pressures (45/25 mmHg) confirm
pulmonary hypertension. The elevated RA pressure (12 mmHg; normal 0–8
mmHg) is consistent with backward transmission of elevated left-sided
pressures. Tricuspid regurgitation would show a prominent V wave in the RA
tracing, and pulmonary stenosis would demonstrate a significant pressure
gradient between RV and PA.
Cardiovascular Pathophysiology
Q4: A 68-year-old male presents with crushing substernal chest pain radiating to
the left arm. ECG shows ST-segment elevation in leads II, III, and aVF with
reciprocal changes in V1–V3. Which coronary artery is most likely occluded?
A. Proximal LAD
B. Proximal left circumflex
C. Right coronary artery
D. Ramus intermedius
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
STEMI. The RCA supplies the inferior wall in approximately 80% of patients (right-
dominant circulation). Reciprocal ST depression in V1–V3 further supports RCA
occlusion affecting the posterior/inferior territory. LAD occlusion would produce
anterior ST elevations (V1–V4).
Q5: A patient with chronic heart failure has an ejection fraction of 25% and
significant left ventricular dilation. Which compensatory mechanism is most
responsible for the progressive ventricular dilation in this patient?
,A. Concentric hypertrophy via pressure overload
B. Frank-Starling mechanism with eccentric hypertrophy
C. Increased diastolic filling with restrictive physiology
D. Enhanced parasympathetic tone reducing heart rate
Correct Answer: B
Rationale: In HFrEF with volume overload, the Frank-Starling mechanism initially
augments stroke volume through increased preload. Chronic volume overload
leads to eccentric hypertrophy (sarcomeres added in series), causing progressive
LV dilation and spherical remodeling. Concentric hypertrophy (Answer A) occurs
with pressure overload (e.g., aortic stenosis), not volume overload.
Q6: Which triad of symptoms is classically associated with severe aortic
stenosis?
A. Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
B. Angina, syncope, and dyspnea
C. Palpitations, chest pain, and sudden cardiac death
D. Jaundice, ascites, and peripheral edema
Correct Answer: B
Rationale: The classic triad of severe aortic stenosis is angina pectoris (due to
increased myocardial oxygen demand and decreased coronary perfusion),
syncope (often exertional, due to inability to augment cardiac output), and
dyspnea (due to elevated LV end-diastolic pressure causing pulmonary
congestion). This triad indicates critical stenosis (valve area <1.0 cm²) and
warrants valve replacement evaluation.
Diagnostic Procedures
Q7: During a standard Bruce protocol exercise stress test, at what point should
the test be terminated based on standard guidelines?
A. Patient achieves 75% of maximum predicted heart rate
B. Patient develops 1 mm of ST-segment depression in a single lead
C. Patient develops severe angina, drop in systolic BP >10 mmHg from baseline,
or sustained ventricular tachycardia
D. Patient requests termination after 6 minutes of exercise
, Correct Answer: C
Rationale: Absolute termination criteria per ACC/AHA guidelines include: severe
angina, drop in systolic BP >10 mmHg from baseline despite increased workload,
sustained VT, ST-segment elevation >1 mm, or signs of poor perfusion. While 1
mm ST depression is significant (Answer B), it alone does not mandate
termination if the patient is asymptomatic. Target heart rate (Answer A) is a goal,
not a termination point.
Q8: A pharmacologic stress test is ordered for a patient with COPD who cannot
perform treadmill exercise. Which agent would be MOST appropriate given the
patient's pulmonary history?
A. Adenosine
B. Dipyridamole
C. Dobutamine
D. Regadenoson
Correct Answer: C
Rationale: Dobutamine is the preferred pharmacologic stress agent for patients
with significant bronchospastic lung disease because adenosine, dipyridamole,
and regadenoson can cause bronchoconstriction via A2B receptor activation in
the lungs. Dobutamine increases myocardial oxygen demand through inotropic
and chronotropic effects without affecting airway tone.
Q9: During a transthoracic echocardiogram, which standard view is obtained by
placing the transducer at the left sternal border in the 4th or 5th intercostal space
with the indicator directed toward the patient's right shoulder?
A. Apical 4-chamber view
B. Parasternal long-axis view
C. Subcostal 4-chamber view
D. Parasternal short-axis view
Correct Answer: B
Rationale: The parasternal long-axis view is obtained from the left parasternal
position with the transducer indicator directed toward the patient's right shoulder
(approximately 10 o'clock). This view visualizes the LV inflow and outflow tracts,
aortic root, mitral valve, and interventricular septum. The apical 4-chamber view
(Answer A) is obtained at the cardiac apex with the indicator toward the left.
– Cardiovascular Credentialing
International (2026 Edition) Study Guide
and Practice Questions
Cardiovascular Anatomy & Physiology
Q1: The left anterior descending (LAD) coronary artery supplies which of the
following myocardial territories?
A. Inferior wall and right ventricle
B. Lateral wall and posterior wall
C. Anterior wall, anteroseptal wall, and apex
D. Right atrium and sinoatrial node in 60% of patients
Correct Answer: C
Rationale: The LAD artery courses down the anterior interventricular groove and
supplies the anterior left ventricular wall, the anterior two-thirds of the
interventricular septum, and the apex. The RCA supplies the inferior wall and SA
node in most patients (Answer D), while the LCx supplies the lateral and posterior
walls (Answer B).
Q2: During the cardiac cycle, which valve closes immediately following the onset
of ventricular systole, producing the first heart sound (S1)?
A. Aortic valve
B. Pulmonic valve
C. Mitral and tricuspid valves
D. Mitral valve only
Correct Answer: C
Rationale: S1 is produced by closure of the atrioventricular (AV) valves—the
mitral and tricuspid valves—at the beginning of ventricular systole when
ventricular pressure exceeds atrial pressure. The aortic and pulmonic valves
close during ventricular diastole, producing S2.
,Q3: A patient has the following right heart catheterization pressures: RA 12
mmHg, RV 45/12 mmHg, PA 45/25 mmHg, PAWP 18 mmHg. Which hemodynamic
parameter is most consistent with these findings?
A. Normal right-sided pressures
B. Pulmonary hypertension with elevated left atrial pressure
C. Tricuspid regurgitation with normal pulmonary pressures
D. Pulmonary stenosis with right ventricular failure
Correct Answer: B
Rationale: The elevated PAWP (18 mmHg; normal 4–12 mmHg) indicates elevated
left atrial pressure, while the elevated PA pressures (45/25 mmHg) confirm
pulmonary hypertension. The elevated RA pressure (12 mmHg; normal 0–8
mmHg) is consistent with backward transmission of elevated left-sided
pressures. Tricuspid regurgitation would show a prominent V wave in the RA
tracing, and pulmonary stenosis would demonstrate a significant pressure
gradient between RV and PA.
Cardiovascular Pathophysiology
Q4: A 68-year-old male presents with crushing substernal chest pain radiating to
the left arm. ECG shows ST-segment elevation in leads II, III, and aVF with
reciprocal changes in V1–V3. Which coronary artery is most likely occluded?
A. Proximal LAD
B. Proximal left circumflex
C. Right coronary artery
D. Ramus intermedius
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
STEMI. The RCA supplies the inferior wall in approximately 80% of patients (right-
dominant circulation). Reciprocal ST depression in V1–V3 further supports RCA
occlusion affecting the posterior/inferior territory. LAD occlusion would produce
anterior ST elevations (V1–V4).
Q5: A patient with chronic heart failure has an ejection fraction of 25% and
significant left ventricular dilation. Which compensatory mechanism is most
responsible for the progressive ventricular dilation in this patient?
,A. Concentric hypertrophy via pressure overload
B. Frank-Starling mechanism with eccentric hypertrophy
C. Increased diastolic filling with restrictive physiology
D. Enhanced parasympathetic tone reducing heart rate
Correct Answer: B
Rationale: In HFrEF with volume overload, the Frank-Starling mechanism initially
augments stroke volume through increased preload. Chronic volume overload
leads to eccentric hypertrophy (sarcomeres added in series), causing progressive
LV dilation and spherical remodeling. Concentric hypertrophy (Answer A) occurs
with pressure overload (e.g., aortic stenosis), not volume overload.
Q6: Which triad of symptoms is classically associated with severe aortic
stenosis?
A. Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
B. Angina, syncope, and dyspnea
C. Palpitations, chest pain, and sudden cardiac death
D. Jaundice, ascites, and peripheral edema
Correct Answer: B
Rationale: The classic triad of severe aortic stenosis is angina pectoris (due to
increased myocardial oxygen demand and decreased coronary perfusion),
syncope (often exertional, due to inability to augment cardiac output), and
dyspnea (due to elevated LV end-diastolic pressure causing pulmonary
congestion). This triad indicates critical stenosis (valve area <1.0 cm²) and
warrants valve replacement evaluation.
Diagnostic Procedures
Q7: During a standard Bruce protocol exercise stress test, at what point should
the test be terminated based on standard guidelines?
A. Patient achieves 75% of maximum predicted heart rate
B. Patient develops 1 mm of ST-segment depression in a single lead
C. Patient develops severe angina, drop in systolic BP >10 mmHg from baseline,
or sustained ventricular tachycardia
D. Patient requests termination after 6 minutes of exercise
, Correct Answer: C
Rationale: Absolute termination criteria per ACC/AHA guidelines include: severe
angina, drop in systolic BP >10 mmHg from baseline despite increased workload,
sustained VT, ST-segment elevation >1 mm, or signs of poor perfusion. While 1
mm ST depression is significant (Answer B), it alone does not mandate
termination if the patient is asymptomatic. Target heart rate (Answer A) is a goal,
not a termination point.
Q8: A pharmacologic stress test is ordered for a patient with COPD who cannot
perform treadmill exercise. Which agent would be MOST appropriate given the
patient's pulmonary history?
A. Adenosine
B. Dipyridamole
C. Dobutamine
D. Regadenoson
Correct Answer: C
Rationale: Dobutamine is the preferred pharmacologic stress agent for patients
with significant bronchospastic lung disease because adenosine, dipyridamole,
and regadenoson can cause bronchoconstriction via A2B receptor activation in
the lungs. Dobutamine increases myocardial oxygen demand through inotropic
and chronotropic effects without affecting airway tone.
Q9: During a transthoracic echocardiogram, which standard view is obtained by
placing the transducer at the left sternal border in the 4th or 5th intercostal space
with the indicator directed toward the patient's right shoulder?
A. Apical 4-chamber view
B. Parasternal long-axis view
C. Subcostal 4-chamber view
D. Parasternal short-axis view
Correct Answer: B
Rationale: The parasternal long-axis view is obtained from the left parasternal
position with the transducer indicator directed toward the patient's right shoulder
(approximately 10 o'clock). This view visualizes the LV inflow and outflow tracts,
aortic root, mitral valve, and interventricular septum. The apical 4-chamber view
(Answer A) is obtained at the cardiac apex with the indicator toward the left.
