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

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.

Authors+Show Affiliations

Department of Dentistry, Jamia Islamia Ishaatul Uloom (JIIU)'s Indian Institute of Medical Science & Research Medical College, Jalna, India.Department of Dentistry, Jamia Islamia Ishaatul Uloom (JIIU)'s Indian Institute of Medical Science & Research Medical College, Jalna, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31508353

Citation

Jadhav, Ajinath Nanasaheb, and Pooja Raosaheb Tarte. "Acute Cardiovascular Complications in Patients With Diabetes and Hypertension: Management Consideration for Minor Oral Surgery." Journal of the Korean Association of Oral and Maxillofacial Surgeons, vol. 45, no. 4, 2019, pp. 207-214.
Jadhav AN, Tarte PR. Acute cardiovascular complications in patients with diabetes and hypertension: management consideration for minor oral surgery. J Korean Assoc Oral Maxillofac Surg. 2019;45(4):207-214.
Jadhav, A. N., & Tarte, P. R. (2019). Acute cardiovascular complications in patients with diabetes and hypertension: management consideration for minor oral surgery. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 45(4), pp. 207-214. doi:10.5125/jkaoms.2019.45.4.207.
Jadhav AN, Tarte PR. Acute Cardiovascular Complications in Patients With Diabetes and Hypertension: Management Consideration for Minor Oral Surgery. J Korean Assoc Oral Maxillofac Surg. 2019;45(4):207-214. PubMed PMID: 31508353.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute cardiovascular complications in patients with diabetes and hypertension: management consideration for minor oral surgery. AU - Jadhav,Ajinath Nanasaheb, AU - Tarte,Pooja Raosaheb, Y1 - 2019/08/28/ PY - 2018/10/21/received PY - 2018/12/09/revised PY - 2018/12/16/accepted PY - 2019/9/12/entrez PY - 2019/9/12/pubmed PY - 2019/9/12/medline KW - Cardiovascular complications KW - Diabetes KW - Hypertension KW - Oral surgery SP - 207 EP - 214 JF - Journal of the Korean Association of Oral and Maxillofacial Surgeons JO - J Korean Assoc Oral Maxillofac Surg VL - 45 IS - 4 N2 - 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. SN - 2234-7550 UR - https://www.unboundmedicine.com/medline/citation/31508353/Acute_cardiovascular_complications_in_patients_with_diabetes_and_hypertension:_management_consideration_for_minor_oral_surgery L2 - http://www.jkaoms.org/journal/view.html?volume=45&number=4&page=207 DB - PRIME DP - Unbound Medicine ER -
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