Brief Answer:
Possible clinical scenarios as follows :

Detailed Answer:
Hello!

Thank you for asking on HCM!

Regarding your concern, I would like to explain that for determining the exact mechanism(s) and etiology of recent health issue, it is very important to review all your clinical scenario and performed medical tests.

Did you experience chest pain during or after the dental procedure? Shortness of breath? Palpitations? Headache? Skin or mucous rash/edema? Nausea? Etc?

What was your vital signs (heart rate, BP, O2sat, etc) before and after your reached the hospital?

Nevertheless, as you have normal previous coronary angiography, and other cardiac tests, the two most probably clinical scenaruos may be:

(1) A bout of an excessive hyperdynamic state (abnormally high blood pressure, racing heart rate and possible arrhythmia), which may have leaded to overall and chest discomfort, dyspnea, palpitations, headache, possible vertigo, nausea, etc. Epinephrine which is generally used with anesthetics, anxiety about the procedure, possible pain, etc, may have contributed altogether bringing this clinical consequence. Not rarely, this clinical scenario, is inevitable, despite a good pre medication.

(2) A possible hypersensitivity to Marcaine (which is already known from several clinical cases in medical literature), may have leaded to a hypersensitivity reaction with all its underlying consewuences. This last possible option is supported by the fact you are atopic (allergic) to seversl foods and compounds.Even this scenario could not be predicted by your dentist, as it is rare.

Both the above mentioned possibilities need close medical evaluation and prompt intervention on a hospital regimen, as they may be sometimes dangerous.

I recommend you to discuss with your attending physician about the exact hospital conclusions on the matter, as it may jeopardise your future dental procedures, if uncertainties remain unresolved.

Hope to have been helpful to you!

Feel free to ask me whenever you need! Greetings! Dr. Iliri

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Brief Answer:
You need to discuss with your health insurance company.

Detailed Answer:
Hello again!

From your about explanations, it seems that an excessive hyper-dynamic state (the first possibility I mentioned above) is the most probable explanation.

It doesn't seem to be an allergy issue.

I am sorry to hear that your health insurance company will not cover your hospital treatment.

I think that, this is due of the fact how they may interpret all this history.

They may think, it was just an iatrogenic complication (that is a complication caused by your dentist's negligent applied therapy.

In fact it is recommended that in coronary artery disease patients, it shouldn't be applied anesthetics with epinephrine (as the latter causes blood vessel constriction and may trigger an acute myocardial ischemia and serious complication, like myocardial infarction, arrhythmia, etc.)

But, you were screened for your coronary arteries before and nothing wrong was found. So, your dentist doesn't seem to have applied an inappropriate therapy.

From the other hand, no previous resistant hypertension has been documented on your medical file. This is explained even by your nonexistent anti-hypertensive therapy (as Atenolol 50 mg is a minimal dose, and is not considered a really efficacious BP lowering therapy). So, even from this point, no absolute contraindications for using Marcaine plus Epinephrine could result.

Coming to this point, I could conclude that no clear contraindications for adding Epi exists. And no iatrogenic complications could be clearly demonstrated, unless your dentist may have used an abnormally high anesthetic dose (but I can hardly believe that???!!!)

When dealing with health insurance companies, it is important to clarify all the financial coverage points before agreement, as their sophisticated attorney offices always try to reduce company expenses by formulating remission rules (convenient for the company).

I personally had such an experience with my car insurance company; when I needed their coverage, they told me some sentences written in so small letters, I could not read when signed our agreement paper.

In your case it seems to be only a bad luck.

I recommend you to discuss again with your health insurance company, and ask them if they can really prove it was just a iatrogenic complication, and where do they support such hypothesis (was it abnormally increased anesthetics dose?? or was there any clear contraindications for not using such a therapy?? or a negligence was found on the dentist management strategy, documented on your personal dental file??

I personally think that answering these three questions, will finally clarify this issue.

Wishing you a good health!

Best regards,

Dr. Iliri

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