A patient with a history of myocardial infarction becomes lightheaded when the dental chair is returned to the upright position. What should you do?

Correct answer: A. Return the patient to a supine position with the legs slightly elevated

• A. CORRECT. This is ORTHOSTATIC (postural) HYPOTENSION — a very common event when a medicated cardiac patient is brought upright too quickly, because baroreceptor compensation is blunted by beta blockers, diuretics, ACE inhibitors, and nitrates. Returning the patient supine with legs slightly elevated restores cerebral perfusion within seconds. Then raise the chair slowly and let the patient sit at the edge before standing.
• B. Nitroglycerin LOWERS blood pressure further and would worsen the episode. It is for ischemic chest pain, not lightheadedness.
• C. EMS is not needed for a simple postural episode that resolves on repositioning; reserve it for loss of consciousness that does not recover, chest pain, or neurologic deficit.
• D. Epinephrine has no role — there is no anaphylaxis and it would be dangerous in a post-MI patient.

Note: Prevent it: raise the chair in stages and let post-MI and elderly patients sit upright for a minute before standing.