J Korean Assoc Oral Maxillofac Surg.  2019 Aug;45(4):207-214. 10.5125/jkaoms.2019.45.4.207.

Acute cardiovascular complications in patients with diabetes and hypertension: management consideration for minor oral surgery

• Jadhav AN
• Tarte PR

• KMID: 2456039
• DOI: http://doi.org/10.5125/jkaoms.2019.45.4.207

Abstract

OBJECTIVES
Medically compromised patients often fear required dental surgical procedures that can increase the risk of medical emergency when combined with reduced tolerance for stress. A stress reduction protocol (SRP) helps doctors minimize treatment-related stress and improves patient management with minimum complications. Diabetes and co-morbid hypertension carry 4-fold risk of aggravation of cardiovascular emergencies and 7.2-fold risk of mortality. Diabetic neuropathy can result in difficult diagnosis of myocardial infarction and reduces chances of surviving a myocardial infarction compared with a non-diabetic person. The aim of the study was to assess the feasibility of a protocol for management of patients having both diabetes and hypertension who required minor oral surgery to minimize the rate of cardiovascular emergencies.
MATERIALS AND METHODS
A prospective study was conducted in 140 patients having both diabetes and hypertension who required minor oral surgical procedures. A systematic approachable protocol was designed for management of such patients.
RESULTS
Among 140 patients, 6 patients (4.3%) had cardiovascular complications, while 3 patients (1 with syncope and 2 with hypertension) did not require any intervention other than observation. Two patients were managed with aspirin and nitroglycerin, and 1 patient had possible myocardial infarction (overall incidence 0.7%) with chest pain, S-T segment elevation on electrocardiogram, and troponin level of 0.60 ng/mL.
CONCLUSION
The proposed protocol helps to improve management of patients having both diabetes and hypertension. We recommend that patients with uncontrolled diabetes and uncontrolled hypertension and/or patients having history of cardiovascular complication should be treated in a medical facility with a readily available cardiology unit. This facilitates prompt response to emergency and instant implementation of treatment, helping to reduce morbidity and mortality.

Keyword

Diabetes; Hypertension; Cardiovascular complications; Oral surgery

MeSH Terms

Aspirin
Cardiology
Chest Pain
Diabetic Neuropathies
Diagnosis
Electrocardiography
Emergencies
Humans
Hypertension*
Incidence
Mortality
Myocardial Infarction
Nitroglycerin
Oral Surgical Procedures
Prospective Studies
Surgery, Oral*
Syncope
Troponin
Aspirin
Nitroglycerin
Troponin

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