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The correct answer is D. 0.04 mg.
For a patient with clinically significant cardiovascular disease, such as angina pectoris, the American Heart Association (AHA) and the American Dental Association (ADA) recommend limiting the dose of epinephrine (adrenaline) to a "cardiac dose."
In healthy patients, the maximum recommended dose of epinephrine is generally 0.2 mg (equivalent to approximately 11 cartridges of 1:100,000 epinephrine). However, in patients with ischemic heart disease or unstable angina, the exogenous administration of adrenaline can trigger adverse hemodynamic effects.
Adrenaline acts on alpha and beta receptors, leading to:
Increased Myocardial Oxygen Demand: Due to positive inotropic (contractility) and chronotropic (heart rate) effects.
Potential Ischemia: In a patient with narrowed coronary arteries (angina), the inability of the coronary blood flow to meet this increased oxygen demand can precipitate a myocardial infarction or severe arrhythmia.
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