This study found that dental treatment with 2% lidocaine with 1:100,000 epinephrine did not provoke myocardial ischemia, as assessed by greater than or equal to 1 mm of ST segment depression. Although in some cases systolic and diastolic blood pressure and rate pressure product increased slightly after local anesthetic administration, these changes were not statistically significant. Because these patients were medically supervised and compliant with cardiac therapy, this study suggests that such patients are not at great risk while receiving local anesthesia with 1:100,000 epinephrine for routine dental care.