1. Cardiovascular diseases Dr Hazem Al-Ahmad B.D.S, MSc(Lon), F.D.S.R.C.S (Eng)

2. Cardiovascular disease Oral-maxillofacial surgery has minor direct imapct on vital organ systems. Physiologic stresses produced by surgery and anaesthetic techniques can lead to serious morbidity and mortality

3. Ischaemic heart disease Insufficent blood supply to the myocardium due to coronary artery obstruction and spasm – myocardial ischaemia. Angina pectoris – stable/unstable Risk factors: family hx, male, increased cholesterol, hypertension, smoking. Nitroglycerin – submucosal for angina only.

4. ECG: ST elevation Can detect old infarct Chest x-ray: can detect congestive heart failure Condition needs to be controlled before surgery. Postpone surgery after MI for 6 months – risk of re-infarction.

5. Myocardial infarction Infarcted area become non-functional and necrotic – dysrhythmias. May need a pacemaker Some pts receive aspirin or anticoagulants Anxiety-reduction protocol Prohpylactic GTN

6. Heart failure Right and left ventricular dysfunction Diseased myocardium can not meet the demand – pulmonary edema, hepatic dysfunction Orthopnea, paroxysmal nocturnal dyspnea

7. High risk for major cardiac events Risk can be reduced with: Diuretic therapy Afterload reduction Digoxin therapy Anxiety-reduction program Avoid excessive epinephrine No supine position

8. Coronary artery bypass grafting Delay major surgery for 6 months after CABG, Routine MOS can be safely performed with anxiety reduction protocols.

9. Coronary angioplasty Same for angina patients

10. Cardiovascular accidents Patients on anticoagulants Blood pressure lowering agents Anxiety reduction protocols Oxygen suuplements

11. Dysrhythmias Decrease epinephrine Anticoagulants or pacemakers (avoid electric cautery)

12. Hypertension Essential hypertension Damage to vital organs: kidneys, brain, heart. Many treatment options: diuretics,ACE inhibitors, angiotensin receptor blockers, B- blockers, calcium channels blockers and others. Delay elective surgery if uncontrolled. Low anxiety, low epinephrine.