Medical ConditionsCardiac & respiratory: Cardiac arrhythmias
Medical ConditionsCardiac & respiratory: Cardiac arrhythmias
Cardiac arrhythmias
Overview
Board takeaway: Define the rhythm diagnosis and stability before care; new symptomatic arrhythmia requires immediate assessment rather than an elective dental procedure.
What is a cardiac arrhythmia?
An abnormal rhythm, rate, or conduction pattern may arise above the ventricles or within them. Causes include congenital or acquired heart disease, inherited electrical disorders, electrolyte disturbance, illness, medications, and autonomic responses. Sinus tachycardia and supraventricular tachycardia are different diagnoses.
Which symptoms make a cardiac arrhythmia clinically important?
Palpitations, dizziness, syncope, chest discomfort, dyspnea, or exercise intolerance require assessment. Infants may show pallor, irritability, poor feeding, or signs of heart failure. Some rhythms are asymptomatic and benign; others threaten perfusion. The actual rhythm diagnosis, electrocardiogram, age, and hemodynamic status determine significance.
How should dental care be planned for a child with a known arrhythmia?
- Cardiology plan: diagnosis, triggers, control, current drugs, and any pacemaker or defibrillator.
- Stress and drugs: provide analgesia and tolerable appointments; agree on vasoconstrictor and sedation use when clinically relevant.
- Interactions: review QT-prolonging medicines and interactions with antiarrhythmics or digoxin before choosing antibiotics or other drugs.
- Devices: follow device-specific electromagnetic-interference guidance for electrical equipment.
- Bleeding: prescribed anticoagulation requires a procedure-specific plan; do not discontinue it independently.
Do cardiac arrhythmias or pacemakers require antibiotic prophylaxis?
Neither an arrhythmia nor a pacemaker alone is an indication. Assess any separate qualifying cardiac lesion, previous infective endocarditis, valve prosthesis, or relevant repair status and whether the procedure manipulates gingiva, periapical tissue, or perforates oral mucosa.
What should happen if symptomatic tachycardia or collapse develops during dental care?
Stop treatment, remove materials from the mouth, assess airway, breathing, and circulation, and activate emergency medical services for instability or concerning persistent symptoms. Provide resuscitation and use an automated external defibrillator when indicated. Adenosine, cardioversion, and antiarrhythmic selection belong to an appropriately trained emergency team using the identified rhythm; do not treat every rapid pulse with one drug sequence.