Screening for Cardiac Problems Advised Before Treating ADHD   Frank Barnhill M.D.
 

The American Heart Association has recently advised children and adults should be assessed for possible cardiac problems before starting drugs for ADHD treatment. This is particularly true when your doctor wishes to start a stimulant ADHD medication such as methylphenidate or amphetamines. Both drugs have been used for many years in ADHD therapy and most ADHDer’s have few major problems with them. However, these drugs may pose a significant risk of heart problems in children or adults with pre-existing cardiac abnormalities.

The cardiac conditions most likely to cause problems when ADHD medications are started include:

• Long QT syndrome, an abnormality of slower than normal electrical conduction between different heart chambers
• Wolf-Parkinson-White Syndrome (WPW), an abnormality of faster than normal electrical conduction between the upper (Atria) and lower (ventricles) chambers of the heart
• Hypertrophic cardiomyopathy, an enlargement of ventricular heart muscle

All of these conditions can be detected or suspected by doing a simple test in your Family Doctor’s office called an electrocardiogram (EKG). It only takes a few minutes and may save you a lot of heartbreak and headaches later.

Why is detection of these conditions so important?

Each of these cardiac conditions may place a child at risk for arrhythmias (abnormal irregular heartbeats) or sudden death (the heart simply stops abruptly). Sudden death is often seen in athletes who use cocaine (a stimulant) and then try to participate in basketball or other strenuous sports.

Your ADHD doctor will want to know about signs and symptoms of heart disease in both the person to be treated, as well as the rest of the family.

Of particular note in the person to be treated would be a history of:

• Skipped, irregular or rapid heartbeat
• Chest discomfort with exercise
• Unexplained shortness of breath, especially with exertion
• Finding a heart murmur at any age
• Dizziness or fainting, especially with exercise
• Sudden decrease in ability to exercise
• Seizures of any type
• Rheumatic fever or any heart disease caused by an infection
• High blood pressure

Things to tell your doctor about your family’s medical history include:

• Heart attack or a heart related death in anyone younger than 35 years
• Sudden death of a young family member whether during exercise or not
• Heart palpitations or conditions requiring heart medications
• Unexplained death of any young person
• Genetic disorders, such as Marfan’s Syndrome

In addition, your ADHD doctor will need to know about:

• All medications currently taken, including over the counter drugs, herbs and supplements
• Cigarette or alcohol use
• Possible illegal drug use

What can you do to help avert this potential catastrophe?

• Be sure your ADHD doctor gets all of the “right information”
• Do not with hold any history of alcohol or drug use no matter how embarrassing
• Insist on a thorough physical exam before medications are started
• Be sure an electrocardiogram (EKG) is done during the assessment

As your ADHD child or spouse’s “Success Advocate”, it’s your job to be sure your ADHDer’s condition is thoroughly evaluated and properly treated. This includes the need for assessment of medical conditions that pose a problem with ADHD medications. By ensuring proper work-up, you will possibly avoid many very serious problems and prevent possible drug related lethal interactions with medicines that normally are considered very safe.

Dr. Frank

Reference: Family Practice News, May 1, 2008

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