A patient with a history of rheumatic fever and a heart murmur would generally require what before dental work?

Patients with a history of rheumatic fever and a heart murmur are at increased risk for developing infective endocarditis, an infection of the heart's inner lining or valves. Invasive dental procedures can introduce bacteria into the bloodstream, which may lead to this serious condition, especially in individuals with pre-existing heart conditions.

Pre-medication refers to the administration of antibiotics prior to dental work to minimize this risk. Guidelines from organizations like the American Heart Association recommend antibiotic prophylaxis for certain high-risk individuals undergoing dental procedures that may cause bleeding. Therefore, pre-medication is the appropriate and necessary precaution to take before dental work to protect the patient’s heart health in this scenario.

The other options do not directly address the prevention of infective endocarditis in this context. Anticoagulants are not routinely prescribed solely due to a history of rheumatic fever. General anesthesia is not specifically indicated unless there are other clinical reasons for its use. A referral to an orthopedist is unrelated to the cardiac considerations associated with dental procedures.