Prior to a dental examination or intervention / procedure, every patient should undergo a thorough clinical examination. A significant proportion of dental patients consists of geriatric horses, and older horses are at a higher risk to suffer from co-morbidities, including cardiac problems. Clinicians should therefore take the time to carefully listen to the heart and assess whether the patient is safe to be sedated for the procedure. This presentation will give you a practical explanation how you can assess whether the horse can be safely sedated or not based on the clinical cardiac findings, and when further diagnostics are indicated (such as an ECG or an echocardiography) Furthermore, some supportive measures are discussed that can be indicated for certain patients during the procedure. Client communication is key when dealing with a dental patient that also has cardiac issues.