RCIS 2026/2027 | Comprehensive Certification Examination CCI Registered Cardiovascular Invasive Specialist
RCIS 2026/2027
340 QUESTIONS | WITH COMPLETE SOLUTIONS | 47 PAGES
Comprehensive Certification Examination for the Registered Cardiovascular Invasive Specialist (RCIS)
Credential. This examination is aligned with the Cardiovascular Credentialing International (CCI) RCIS Exam
Content Outline, Invasive Cardiovascular Technology Competencies, and Cath Lab Standards (2026/2027 Edition).
The exam comprises 150 multiple-choice questions distributed across eleven (11) core content domains. Cognitive
level distribution targets 25% recall, 50% application, and 25% analysis, including hemodynamic calculations,
waveform interpretation, angiographic image interpretation, and clinical decision-making. Approximately 75% of
items are scenario-based, reflecting authentic cath-lab clinical practice. Each question includes a single best answer
(A-D) and a complete rationale referencing the CCI RCIS content outline and established invasive cardiovascular
standards. Time allocation: 3 hours. Passing threshold (institutional mock): 70%.
Section Domain Q# Count
1 Cardiovascular Anatomy & Physiology Q1 - Q20 20
2 Radiation Safety & Imaging Q21 - Q35 15
3 Hemodynamic Monitoring & Calculations Q36 - Q55 20
4 Diagnostic Cardiac Catheterization Q56 - Q75 20
5 Coronary Anatomy & Angiography Q76 - Q90 15
6 Percutaneous Coronary Intervention (PCI) Q91 - Q105 15
7 Adjunctive Devices & Techniques Q106 - Q115 10
8 Electrophysiology & Pacemakers Q116 - Q125 10
9 Complications & Emergency Management Q126 - Q135 10
10 Pharmacology & Contrast Media Q136 - Q145 10
11 Quality Assurance & Patient Care Q146 - Q150 5
TOTAL Q1 - Q150 150
Examination Instructions
1. Each question has ONE best answer. Select the single most appropriate option (A, B, C, or D).
2. Marked answers must be recorded before time expires. Total time: 3 hours (180 minutes) for 150 questions (~1.2
min/question).
3. Hemodynamic calculation questions may use the following reference values: normal LVEDP 8-12 mmHg; normal
PCWP 6-12 mmHg; normal PA 25/10 mmHg (mean 15); normal CO 4-8 L/min; normal CI 2.5-4.0 L/min/m^2; normal
SVR 800-1200 dynes-sec/cm^5; normal PVR <250 dynes-sec/cm^5; Fick CO = O2 consumption / (CaO2 - CvO2).
RCIS 2026/2027 Examination | 150 Questions with Complete Solutions Page 1
,RCIS 2026/2027 | Comprehensive Certification Examination CCI Registered Cardiovascular Invasive Specialist
4. Gorlin formula: Valve Area = CO / (SEP x HR x 44.3 x sqrt(mean gradient)). Qp/Qs ratio normal = 1.0 (shunt if
Qp/Qs >1.5 or <0.7).
5. Calculators are permitted for arithmetic; clinical judgment and reasoning remain the assessed competency.
6. Passing threshold: 70% (105/150). Domain-specific feedback will be provided after scoring.
BEGIN EXAMINATION
Section 1: Cardiovascular Anatomy & Physiology
Q1: A 58-year-old male is undergoing left heart catheterization. The cardiologist requests a view that best
isolates the left anterior descending artery along its long axis. Which coronary artery segment gives rise to
the diagonal and septal perforator branches?
A. The right posterior descending artery
B. The left circumflex artery
C. The left anterior descending artery *[CORRECT]*
D. The ramus intermedius artery
Correct Answer: C
Rationale: The left anterior descending (LAD) artery gives rise to diagonal branches (supplying the anterolateral left
ventricular wall) and septal perforator branches (supplying the anterior two-thirds of the interventricular septum). The
LCx gives obtuse marginals; the PDA arises from the RCA in a right-dominant circulation. The ramus intermedius is an
anatomic variant that arises directly from the left main trunk when present, not the source of diagonals. CCI RCIS
content outline requires knowledge of coronary arterial tree branching for angiographic identification.
Q2: During right heart catheterization, the catheter tip enters a chamber with a tricuspid valve on its
inflow side and a pulmonary valve on its outflow side. Which cardiac chamber is being catheterized?
A. Right atrium
B. Right ventricle *[CORRECT]*
C. Left atrium
D. Left ventricle
Correct Answer: B
Rationale: The right ventricle is bounded by the tricuspid valve (inflow from right atrium) and the pulmonary valve
(outflow to the pulmonary artery). The right atrium receives systemic venous return via the SVC and IVC and has the
coronary sinus ostium. The left-sided chambers contain mitral and aortic valves. Identifying chambers by their
inflow/outflow valves is fundamental CCI RCIS anatomy content tested under hemodynamic waveform interpretation.
Q3: A patient has a left dominant coronary circulation. Which artery supplies the posterior descending
artery (PDA) and the AV nodal branch in this patient?
A. Right coronary artery (RCA)
B. Left anterior descending artery (LAD)
C. Left circumflex artery (LCx) *[CORRECT]*
D. Conus branch of the RCA
Correct Answer: C
RCIS 2026/2027 Examination | 150 Questions with Complete Solutions Page 2
,RCIS 2026/2027 | Comprehensive Certification Examination CCI Registered Cardiovascular Invasive Specialist
Rationale: In approximately 8-10% of individuals (left-dominant circulation), the PDA arises from the left circumflex
artery (LCx) rather than the RCA. The LCx also supplies the AV nodal branch in left-dominant hearts. In right-dominant
circulation (85%), the RCA gives rise to the PDA at the crux cordis. Dominance is determined angiographically by
which artery crosses the crux and supplies the inferior septum. This anatomical concept is essential CCI RCIS content
for coronary angiography interpretation.
Q4: A coronary sinus catheter is being positioned for an electrophysiology study. Into which cardiac
structure does the coronary sinus directly drain?
A. Superior vena cava
B. Inferior vena cava
C. Right atrium *[CORRECT]*
D. Left atrium
Correct Answer: C
Rationale: The coronary sinus is the largest cardiac vein and drains deoxygenated blood from the myocardium directly
into the right atrium, between the IVC and tricuspid valve. Its orifice is guarded by the Thebesian valve. This venous
return mixes with systemic venous blood in the right atrium before entering the right ventricle. Anatomical knowledge
of the coronary sinus is critical for EP catheter placement, retrograde cardioplegia delivery, and LV lead implantation
for CRT, all of which are tested on the RCIS exam.
Q5: An invasive cardiovascular technologist is reviewing a 12-lead ECG during a cath procedure. The PR
interval is generated by depolarization of which cardiac structures?
A. SA node only
B. SA node, atria, AV node, bundle of His, and Purkinje fibers *[CORRECT]*
C. AV node and bundle branches only
D. Bundle branches and Purkinje fibers only
Correct Answer: B
Rationale: The PR interval (normal 0.12-0.20 sec) represents the time from onset of atrial depolarization through the
SA node, atrial muscle, AV node, bundle of His, bundle branches, and Purkinje fibers up to the onset of ventricular
depolarization. The largest portion of the PR interval is conduction delay through the AV node, allowing for adequate
ventricular filling. The QRS complex represents ventricular depolarization, and the QT interval represents total
ventricular systole. CCI RCIS exam content includes ECG-correlated conduction system anatomy.
Q6: During hemodynamic monitoring, the dicrotic notch on the aortic pressure waveform corresponds to
which cardiac cycle event?
A. Mitral valve opening
B. Aortic valve closure *[CORRECT]*
C. Aortic valve opening
D. Tricuspid valve closure
Correct Answer: B
Rationale: The dicrotic notch (incisura) on the aortic pressure waveform marks aortic valve closure at the end of
ventricular systole. As the LV pressure falls below aortic pressure, backflow snaps the aortic valve leaflets closed,
creating a momentary pressure rise visible as the dicrotic notch. This event marks the beginning of diastole. The mitral
valve opens later, when LV pressure falls below LA pressure, initiating rapid ventricular filling. Recognizing waveform
landmarks is a foundational RCIS hemodynamic interpretation skill.
Q7: A patient in the cath lab demonstrates a cardiac output of 5.0 L/min with a heart rate of 80 bpm.
Calculate the stroke volume.
A. 40 mL
RCIS 2026/2027 Examination | 150 Questions with Complete Solutions Page 3
, RCIS 2026/2027 | Comprehensive Certification Examination CCI Registered Cardiovascular Invasive Specialist
B. 62.5 mL *[CORRECT]*
C. 80 mL
D. 100 mL
Correct Answer: B
Rationale: Stroke Volume (SV) = Cardiac Output (CO) / Heart Rate (HR). SV = 5000 mL/min / 80 bpm = 62.5 mL.
Normal SV ranges 60-100 mL. Cardiac output is the product of stroke volume and heart rate (CO = SV x HR). This
calculation is a core hemodynamic competency required by the CCI RCIS exam content outline under hemodynamic
calculations.
Q8: A 65-year-old female has a blood pressure of 120/80 mmHg and a heart rate of 70 bpm. Using the
standard formula for mean arterial pressure (MAP), calculate her MAP.
A. 86.7 mmHg
B. 93.3 mmHg *[CORRECT]*
C. 100 mmHg
D. 80 mmHg
Correct Answer: B
Rationale: Mean Arterial Pressure (MAP) = DBP + 1/3(SBP - DBP) = 80 + 1/3(120-80) = 80 + 13.3 = 93.3 mmHg.
MAP represents the average arterial pressure throughout the cardiac cycle and is the driving pressure for organ
perfusion. The 1/3 weighting reflects the fact that diastole lasts approximately twice as long as systole at rest. MAP
calculation is foundational hemodynamic content tested on the RCIS exam.
Q9: According to the Frank-Starling law of the heart, increased ventricular preload results in which
hemodynamic change?
A. Decreased stroke volume
B. Increased stroke volume due to enhanced myocardial fiber stretch *[CORRECT]*
C. Increased afterload only
D. Decreased heart rate
Correct Answer: B
Rationale: The Frank-Starling law states that increased ventricular filling (preload) stretches myocardial sarcomeres,
optimizing actin-myosin crossbridge overlap and producing a stronger contraction with increased stroke volume. This
intrinsic mechanism allows the heart to match output to venous return. Excessive preload, however, over-stretches
sarcomeres beyond the optimal length and reduces contractility (descending limb). Understanding preload-contractility
relationships is essential CCI RCIS content under cardiac physiology.
Q10: Which fetal circulatory structure allows most oxygenated blood from the IVC to bypass the right
ventricle and directly enter the left atrium?
A. Ductus arteriosus
B. Foramen ovale *[CORRECT]*
C. Ductus venosus
D. Ligamentum arteriosum
Correct Answer: B
Rationale: The foramen ovale is a one-way flap valve in the fetal interatrial septum that directs oxygenated IVC blood
(from the placenta) across into the left atrium, bypassing the pulmonary circulation. The ductus venosus shunts placental
blood from the umbilical vein to the IVC, while the ductus arteriosus connects the pulmonary artery to the descending
aorta, allowing right ventricular output to bypass the lungs. Knowledge of fetal circulation shunts is required CCI RCIS
content under congenital cardiac anatomy.
Q11: Which of the following coronary arteries courses in the anterior interventricular groove?
RCIS 2026/2027 Examination | 150 Questions with Complete Solutions Page 4
RCIS 2026/2027
340 QUESTIONS | WITH COMPLETE SOLUTIONS | 47 PAGES
Comprehensive Certification Examination for the Registered Cardiovascular Invasive Specialist (RCIS)
Credential. This examination is aligned with the Cardiovascular Credentialing International (CCI) RCIS Exam
Content Outline, Invasive Cardiovascular Technology Competencies, and Cath Lab Standards (2026/2027 Edition).
The exam comprises 150 multiple-choice questions distributed across eleven (11) core content domains. Cognitive
level distribution targets 25% recall, 50% application, and 25% analysis, including hemodynamic calculations,
waveform interpretation, angiographic image interpretation, and clinical decision-making. Approximately 75% of
items are scenario-based, reflecting authentic cath-lab clinical practice. Each question includes a single best answer
(A-D) and a complete rationale referencing the CCI RCIS content outline and established invasive cardiovascular
standards. Time allocation: 3 hours. Passing threshold (institutional mock): 70%.
Section Domain Q# Count
1 Cardiovascular Anatomy & Physiology Q1 - Q20 20
2 Radiation Safety & Imaging Q21 - Q35 15
3 Hemodynamic Monitoring & Calculations Q36 - Q55 20
4 Diagnostic Cardiac Catheterization Q56 - Q75 20
5 Coronary Anatomy & Angiography Q76 - Q90 15
6 Percutaneous Coronary Intervention (PCI) Q91 - Q105 15
7 Adjunctive Devices & Techniques Q106 - Q115 10
8 Electrophysiology & Pacemakers Q116 - Q125 10
9 Complications & Emergency Management Q126 - Q135 10
10 Pharmacology & Contrast Media Q136 - Q145 10
11 Quality Assurance & Patient Care Q146 - Q150 5
TOTAL Q1 - Q150 150
Examination Instructions
1. Each question has ONE best answer. Select the single most appropriate option (A, B, C, or D).
2. Marked answers must be recorded before time expires. Total time: 3 hours (180 minutes) for 150 questions (~1.2
min/question).
3. Hemodynamic calculation questions may use the following reference values: normal LVEDP 8-12 mmHg; normal
PCWP 6-12 mmHg; normal PA 25/10 mmHg (mean 15); normal CO 4-8 L/min; normal CI 2.5-4.0 L/min/m^2; normal
SVR 800-1200 dynes-sec/cm^5; normal PVR <250 dynes-sec/cm^5; Fick CO = O2 consumption / (CaO2 - CvO2).
RCIS 2026/2027 Examination | 150 Questions with Complete Solutions Page 1
,RCIS 2026/2027 | Comprehensive Certification Examination CCI Registered Cardiovascular Invasive Specialist
4. Gorlin formula: Valve Area = CO / (SEP x HR x 44.3 x sqrt(mean gradient)). Qp/Qs ratio normal = 1.0 (shunt if
Qp/Qs >1.5 or <0.7).
5. Calculators are permitted for arithmetic; clinical judgment and reasoning remain the assessed competency.
6. Passing threshold: 70% (105/150). Domain-specific feedback will be provided after scoring.
BEGIN EXAMINATION
Section 1: Cardiovascular Anatomy & Physiology
Q1: A 58-year-old male is undergoing left heart catheterization. The cardiologist requests a view that best
isolates the left anterior descending artery along its long axis. Which coronary artery segment gives rise to
the diagonal and septal perforator branches?
A. The right posterior descending artery
B. The left circumflex artery
C. The left anterior descending artery *[CORRECT]*
D. The ramus intermedius artery
Correct Answer: C
Rationale: The left anterior descending (LAD) artery gives rise to diagonal branches (supplying the anterolateral left
ventricular wall) and septal perforator branches (supplying the anterior two-thirds of the interventricular septum). The
LCx gives obtuse marginals; the PDA arises from the RCA in a right-dominant circulation. The ramus intermedius is an
anatomic variant that arises directly from the left main trunk when present, not the source of diagonals. CCI RCIS
content outline requires knowledge of coronary arterial tree branching for angiographic identification.
Q2: During right heart catheterization, the catheter tip enters a chamber with a tricuspid valve on its
inflow side and a pulmonary valve on its outflow side. Which cardiac chamber is being catheterized?
A. Right atrium
B. Right ventricle *[CORRECT]*
C. Left atrium
D. Left ventricle
Correct Answer: B
Rationale: The right ventricle is bounded by the tricuspid valve (inflow from right atrium) and the pulmonary valve
(outflow to the pulmonary artery). The right atrium receives systemic venous return via the SVC and IVC and has the
coronary sinus ostium. The left-sided chambers contain mitral and aortic valves. Identifying chambers by their
inflow/outflow valves is fundamental CCI RCIS anatomy content tested under hemodynamic waveform interpretation.
Q3: A patient has a left dominant coronary circulation. Which artery supplies the posterior descending
artery (PDA) and the AV nodal branch in this patient?
A. Right coronary artery (RCA)
B. Left anterior descending artery (LAD)
C. Left circumflex artery (LCx) *[CORRECT]*
D. Conus branch of the RCA
Correct Answer: C
RCIS 2026/2027 Examination | 150 Questions with Complete Solutions Page 2
,RCIS 2026/2027 | Comprehensive Certification Examination CCI Registered Cardiovascular Invasive Specialist
Rationale: In approximately 8-10% of individuals (left-dominant circulation), the PDA arises from the left circumflex
artery (LCx) rather than the RCA. The LCx also supplies the AV nodal branch in left-dominant hearts. In right-dominant
circulation (85%), the RCA gives rise to the PDA at the crux cordis. Dominance is determined angiographically by
which artery crosses the crux and supplies the inferior septum. This anatomical concept is essential CCI RCIS content
for coronary angiography interpretation.
Q4: A coronary sinus catheter is being positioned for an electrophysiology study. Into which cardiac
structure does the coronary sinus directly drain?
A. Superior vena cava
B. Inferior vena cava
C. Right atrium *[CORRECT]*
D. Left atrium
Correct Answer: C
Rationale: The coronary sinus is the largest cardiac vein and drains deoxygenated blood from the myocardium directly
into the right atrium, between the IVC and tricuspid valve. Its orifice is guarded by the Thebesian valve. This venous
return mixes with systemic venous blood in the right atrium before entering the right ventricle. Anatomical knowledge
of the coronary sinus is critical for EP catheter placement, retrograde cardioplegia delivery, and LV lead implantation
for CRT, all of which are tested on the RCIS exam.
Q5: An invasive cardiovascular technologist is reviewing a 12-lead ECG during a cath procedure. The PR
interval is generated by depolarization of which cardiac structures?
A. SA node only
B. SA node, atria, AV node, bundle of His, and Purkinje fibers *[CORRECT]*
C. AV node and bundle branches only
D. Bundle branches and Purkinje fibers only
Correct Answer: B
Rationale: The PR interval (normal 0.12-0.20 sec) represents the time from onset of atrial depolarization through the
SA node, atrial muscle, AV node, bundle of His, bundle branches, and Purkinje fibers up to the onset of ventricular
depolarization. The largest portion of the PR interval is conduction delay through the AV node, allowing for adequate
ventricular filling. The QRS complex represents ventricular depolarization, and the QT interval represents total
ventricular systole. CCI RCIS exam content includes ECG-correlated conduction system anatomy.
Q6: During hemodynamic monitoring, the dicrotic notch on the aortic pressure waveform corresponds to
which cardiac cycle event?
A. Mitral valve opening
B. Aortic valve closure *[CORRECT]*
C. Aortic valve opening
D. Tricuspid valve closure
Correct Answer: B
Rationale: The dicrotic notch (incisura) on the aortic pressure waveform marks aortic valve closure at the end of
ventricular systole. As the LV pressure falls below aortic pressure, backflow snaps the aortic valve leaflets closed,
creating a momentary pressure rise visible as the dicrotic notch. This event marks the beginning of diastole. The mitral
valve opens later, when LV pressure falls below LA pressure, initiating rapid ventricular filling. Recognizing waveform
landmarks is a foundational RCIS hemodynamic interpretation skill.
Q7: A patient in the cath lab demonstrates a cardiac output of 5.0 L/min with a heart rate of 80 bpm.
Calculate the stroke volume.
A. 40 mL
RCIS 2026/2027 Examination | 150 Questions with Complete Solutions Page 3
, RCIS 2026/2027 | Comprehensive Certification Examination CCI Registered Cardiovascular Invasive Specialist
B. 62.5 mL *[CORRECT]*
C. 80 mL
D. 100 mL
Correct Answer: B
Rationale: Stroke Volume (SV) = Cardiac Output (CO) / Heart Rate (HR). SV = 5000 mL/min / 80 bpm = 62.5 mL.
Normal SV ranges 60-100 mL. Cardiac output is the product of stroke volume and heart rate (CO = SV x HR). This
calculation is a core hemodynamic competency required by the CCI RCIS exam content outline under hemodynamic
calculations.
Q8: A 65-year-old female has a blood pressure of 120/80 mmHg and a heart rate of 70 bpm. Using the
standard formula for mean arterial pressure (MAP), calculate her MAP.
A. 86.7 mmHg
B. 93.3 mmHg *[CORRECT]*
C. 100 mmHg
D. 80 mmHg
Correct Answer: B
Rationale: Mean Arterial Pressure (MAP) = DBP + 1/3(SBP - DBP) = 80 + 1/3(120-80) = 80 + 13.3 = 93.3 mmHg.
MAP represents the average arterial pressure throughout the cardiac cycle and is the driving pressure for organ
perfusion. The 1/3 weighting reflects the fact that diastole lasts approximately twice as long as systole at rest. MAP
calculation is foundational hemodynamic content tested on the RCIS exam.
Q9: According to the Frank-Starling law of the heart, increased ventricular preload results in which
hemodynamic change?
A. Decreased stroke volume
B. Increased stroke volume due to enhanced myocardial fiber stretch *[CORRECT]*
C. Increased afterload only
D. Decreased heart rate
Correct Answer: B
Rationale: The Frank-Starling law states that increased ventricular filling (preload) stretches myocardial sarcomeres,
optimizing actin-myosin crossbridge overlap and producing a stronger contraction with increased stroke volume. This
intrinsic mechanism allows the heart to match output to venous return. Excessive preload, however, over-stretches
sarcomeres beyond the optimal length and reduces contractility (descending limb). Understanding preload-contractility
relationships is essential CCI RCIS content under cardiac physiology.
Q10: Which fetal circulatory structure allows most oxygenated blood from the IVC to bypass the right
ventricle and directly enter the left atrium?
A. Ductus arteriosus
B. Foramen ovale *[CORRECT]*
C. Ductus venosus
D. Ligamentum arteriosum
Correct Answer: B
Rationale: The foramen ovale is a one-way flap valve in the fetal interatrial septum that directs oxygenated IVC blood
(from the placenta) across into the left atrium, bypassing the pulmonary circulation. The ductus venosus shunts placental
blood from the umbilical vein to the IVC, while the ductus arteriosus connects the pulmonary artery to the descending
aorta, allowing right ventricular output to bypass the lungs. Knowledge of fetal circulation shunts is required CCI RCIS
content under congenital cardiac anatomy.
Q11: Which of the following coronary arteries courses in the anterior interventricular groove?
RCIS 2026/2027 Examination | 150 Questions with Complete Solutions Page 4
