|
The IAC Standards and Guidelines |
Click here for a printer-friendly PDF of the Adult Echocardiography
Standards |
Stress
test supervision by non-physician training and competency requirements:
1.5.1A If a
non-physician (e.g., properly trained nurse, physician assistant, nurse
practitioner, exercise physiologist) practicing under the physician’s
license is supervising the stress test, the facility or Medical Director must
document appropriate training and competence as outlined in the American
College of Cardiology/American Heart Association Clinical Competence Statement
on Stress Testing. (See Bibliography)
Supervision
of exercise stress testing:
a. Knowledge of appropriate
indications for exercise testing
b. Knowledge of alternative
physiological cardiovascular tests
c.
Knowledge
of appropriate contraindications, risks and risk assessment of testing (not
limited to Bayes’ theorem and sensitivity/specificity, including concepts
of absolute and relative risk)
d. Knowledge to promptly
recognize and treat complications of exercise testing
e.
Competence
in cardiopulmonary resuscitation and successful completion of an AHA-sponsored
course in advanced cardiovascular life support and renewal on a regular basis
f.
Knowledge
of various exercise protocols and indications for each
g.
Knowledge
of basic cardiovascular and exercise physiology, including hemodynamic response
to exercise
h. Knowledge of cardiac
arrhythmias and the ability to recognize and treat serious arrhythmias
i.
Knowledge
of cardiovascular drugs and how they can affect exercise performance,
hemodynamics and the ECG
j.
Knowledge
of the effects of age and disease on hemodynamic and ECG responses to exercise
k. Knowledge of principles
and details of exercise testing, including proper lead placement and skin
preparation
l.
Knowledge
of end points of exercise testing and indications to terminate exercise testing
Supervision
of pharmacologic stress agents:
a. Knowledge of appropriate
indications
b. Knowledge of appropriate
contraindications
c.
Knowledge
of advantages and disadvantages of different exercise and pharmacological
stress for echocardiography.
d. Knowledge of
complications and ability to recognize and appropriately treat complications,
including use of adenosine/dobutamine antagonists such as theophylline and
aminophylline
e.
Competence
in cardiopulmonary resuscitation and successful completion of an AHA-sponsored
course in advanced cardiovascular life support and renewal on a regular basis
f.
Knowledge
of various vasodilator, adrenergic stress protocols
g.
Knowledge
of the pharmacokinetics of vasodilator and adrenergic drugs
h. Knowledge of basic
cardiovascular physiology, including heart rate and blood pressure response to
vasodilators and adrenergic-stimulating agents
i.
Knowledge
of electrocardiography and changes that may occur in response to vasodilators
or adrenergic-stimulating agents
j.
Knowledge
of cardiac arrhythmias and their treatment, including high-grade ventricular
arrhythmia and heart block
k. Knowledge of
cardiovascular drugs (and other agents, e.g., caffeine) and their effects on
vasodilator and adrenergic drugs