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Adrenaline dose caution in cardiovascular disease — ORE Part 1 MCQ

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HardDental Pharmacology and TherapeuticsAdrenaline dose caution in cardiovascular diseaseORE Part 1

A 69-year-old man with stable angina requires extraction of a painful mobile lower molar. He uses sublingual glyceryl trinitrate occasionally, has good exercise tolerance and has no current chest pain. His blood pressure is 148/86 mmHg. He reports palpitations during previous dental injections and is visibly anxious. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Give effective local anaesthesia, limiting adrenaline dose and reducing stress

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as D · D = shown as E

**E is correct.** Stable angina with good exercise tolerance is not, by itself, an indication to avoid dental treatment under local anaesthesia or to arrange general anaesthesia. Adequate analgesia and anxiety reduction limit the endogenous catecholamine response to pain and distress. Use an appropriate low total dose of adrenaline-containing local anaesthetic, inject slowly with aspiration to reduce the risk of intravascular administration, and monitor the patient clinically. Evidence supports low-dose epinephrine-containing dental local anaesthetic in controlled coronary disease. A is unsafe because pain and stress may increase cardiovascular demand. B unnecessarily increases adrenaline exposure. C does not provide definitive management of a painful mobile tooth in the absence of a stated spreading infection. D is disproportionate; general anaesthesia is not routine for stable angina. ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/34266837/?utm_source=openai))

Reference: Guimaraes CC et al. Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis. BMJ Open, 2021. https://pubmed.ncbi.nlm.nih.gov/34266837/