Stimulant medications like those used to treat ADHD can increase heart rate and blood pressure. For most children with ADHD, these side effects are insignificant. For an ADHD child with a pre-existing heart condition, however, this increase in heart rate and blood pressure can increase the risk for sudden cardiac arrest, which occurs when the heartbeat becomes erratic and stops pumping blood through the body.
Because of these concerns, the American Heart Association (AHA) now recommends that children be screened for heart problems with an electrocardiogram (ECG) before being given stimulant medications. Your child’s doctor may typically conduct a physical exam and thorough patient and family history before placing your child on any prescription medicine. However, the ECG can detect abnormalities that these routine evaluations may miss. An ECG measures the heart’s electrical activity and can identify heart rhythm abnormalities such as those that can lead to sudden cardiac death.
“After ADHD is diagnosed, but before therapy with a stimulant or other medication is begun, we suggest that an ECG be added to the pre-treatment evaluation to increase the likelihood of identifying cardiac conditions that may place the child at risk for sudden death,” said Victoria L. Vetter, M.D., head of the statement writing committee and professor of Pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.
In addition, Dr. Vetter also noted that doctors should screen children and adolescents already taking these medications if they did not receive an ECG when they started the treatment. If heart problems are suspected after the evaluation, families should be referred to a pediatric cardiologist. If it is determined appropriate for stimulant treatment to begin, it is recommended that these children have their heart health and blood pressure monitored periodically.
The AHA’s Statement Highlights:
- The side effects of stimulant drugs, like those used to treat ADHD, are usually insignificant, but are important to monitor for children with ADHD and certain heart conditions.
- Children diagnosed with ADHD should receive an electrocardiogram (ECG) to rule out heart abnormalities before beginning treatment with stimulant drugs.
- Children currently taking stimulant drugs who did not have an ECG prior to treatment should get an ECG.
Stimulant Medications Include:
Trade Name (generic name)
- Ritalin (methylphenidate)
- Adderall (amphetamine; dextroamphetamine)
- Adderall XR (amphetamine; dextroamphetamine)
- Concerta (methylphenidate)
- Cylert (pemoline)
- Daytrana (methylphenidate)
- Dexedrine (dextroamphetamine)
- Dextrostat (dextroamphetamine)
- Focalin (dexmethylphenidate)
- Focalin XR (dexmethylphenidate)
- Metadate (methylphenidate)
- Vyvanse (lisdexamfetamine)
Click on Children with ADHD Should Get Heart Tests Before Treatment With Stimulant Drugs to read the complete news release from the American Heart Association.
Additional Thoughts:
According to Vincent Iannelli, MD, About.com's Guide to Pediatrics, the new American Heart Association ADHD guidelines are not without controversy though, as they were published without consulting the American Academy of Pediatrics, whose members would be responsible for following the guidelines. The AAP describes the AHA guidelines as "cautious" and "may not be feasible." Read more from Dr. Iannelli in his Pediatrics Blog.
Click on the following links to learn more about ADHD:
Additional Reading: New Guidelines Urge Heart Tests Before Kids Take ADHD Drugs
Sources:
American Heart Association. News Release. Children with ADHD Should Get Heart Tests Before Treatment With Stimulant Drugs. April 22, 2008.
Victoria L. Vetter, Josephine Elia, Christopher Erickson, Stuart Berger, Nathan Blum, Karen Uzark, Catherine L. Webb. Cardiovascular Monitoring of Children and Adolescents with Heart Disease Receiving Stimulant Drugs. A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing. Circulation: Journal of the American Heart Association. April 21, 2008.
