Heart Failure Dental Management — ORE Part 1 MCQ

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ModerateHuman Disease & Dental ManagementHeart Failure Dental ManagementORE Part 1

A 65-year-old man with stable heart failure (NYHA class II) takes bisoprolol and ramipril. He requires routine restorative dental treatment. What is the most appropriate treatment modification?

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Correct answer: D — Use a semi-upright chair position throughout treatment

**A is correct.** A patient with heart failure may experience orthopnoea—breathlessness when lying flat—so routine dental care should be provided with the chair semi-upright, adjusted to the individual’s tolerance. This is particularly relevant if symptoms develop during treatment. NICE includes breathlessness on lying flat among features of heart failure. **B** is incorrect because heart failure is not, by itself, a contraindication to local anaesthesia. **C** is incorrect because established heart-failure medicines, including beta-blockers, should not be stopped by the dentist; abrupt withdrawal may destabilise cardiovascular control. **D** is disproportionate for stable NYHA class II disease; general anaesthesia is not routinely required. **E** is incorrect because heart failure alone is not an indication for antibiotic prophylaxis before dental procedures.

Reference: NICE, Quality Standard QS9: Chronic heart failure in adults, section describing symptoms of chronic heart failure, updated 2025. https://www.nice.org.uk/guidance/qs9/resources/chronic-heart-failure-in-adults-pdf-58304464837