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The IAC Standards and Guidelines |
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Stress
Test Supervision by Non-Physician Training and Competency Requirements:
1.5.1.1A 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 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 Vasodilator or
Adrenergic-Stimulating Agent Stress:
a.
Knowledge
of appropriate indications.
b.
Knowledge
of appropriate contraindications.
c.
Knowledge
of advantages and disadvantages of different exercise and pharmacological
stress for radionuclide cardiac imaging.
d.
Knowledge
of complications and ability to recognize and appropriately treat
complications, including use of adenosine/dipyridamole 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