Advanced Education In General Dentistry

Patient Case: Cardiac Disease

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J. M. is a 64 year old man referred to the Oral Surgery Clinic for full mouth extractions, alveoloplasty and insertion of an immediate denture. The patient has had multiple extractions in the past and is now very anxious about having further dental work performed without being sedated, and therefore requests to be sedated for this procedure.

PMHx: Coronary Artery Disease, Myocardial Infarction 95' with subsequent Angioplasty, Hypercholesterolemia, Hypertension
Medications: Aspirin, Lipitor, Toprol XL
No Known Drug Allergies

Questions For The Patient

  1. Do you have chest pain? If yes, is frequency quality, location, duration of pain, associated with exercise or at rest? respond to Nitrogylcerin tablets? Are there any accompanying GI symptoms?
  2. Do you have shortness of breath? If yes, with or without exercise? How much exercise prior to SOB?
  3. Do your legs swell?
  4. How many pillows do you sleep with?
  5. How well is you blood pressure controlled?
  6. Any recent changes in your medications?
  7. When was your most recent Angiogram? What were the results? (Are your Coronary arteries occluded?)
  8. When was your last Echocardiogram? What were the results?
  9. Have you had a stress test after your MI? What were the results?

Implications For Sedation

If a patient reports having the above symptoms and/or is uncertain about the condition of their coronary arteries, a medical consultation should be obtained prior to the procedure. Defer elective surgery until 6 months after a myocardial infarction.

The patient that presented to our clinic had no history of chest pain, SOB, peripheral edema. Furthermore he had a recent stress test which was completed without difficulty, with normal results.

Summary Of Treatment

  1. Supplemental Oxygen
  2. BP Monitoring
  3. EKG Monitoring
  4. Light Sedation
  5. Oxygen Saturation Monitoring
  6. Good Local Anesthesia - limit epinephrine
  7. Emergency Drugs Available - Nitroglycerin

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