ADHD Drugs: Heart Screen Recommended
American Heart Association Calls for Electrocardiograms Before Kids Take ADHD Drugs
ADHD Drugs Raise Heart Rate, Blood Pressure continued...
Studies suggest that ADHD is more common in children with heart problems than in the general pediatric population. And the obesity epidemic has led to an epidemic of high blood pressure among children and teens, Vetter says.
Since February 2007, the FDA has required that medications used to treat ADHD be accompanied by information warning about the use of these drugs in patients with heart problems. This has created a variety of dilemmas, including how to determine if a child has heart disease.
Vetter says her own preliminary research suggests that as many as 2% of children in the U.S. have undiagnosed heart problems that could be identified by ECG screening.
"This is definitely an issue that needed to be addressed," she says. The goal of the updated recommendations is to "allow treatment of this very significant problem of ADHD while attempting to lower the risk of these [medications]."
ECG Should Be Routine
The AHA panel's pretreatment recommendations include:
- Taking a thorough medical history prior to treatment, with special attention given to symptoms that might indicate heart problems, such as heart palpitations, high blood pressure, heart murmur, fainting or near-fainting episodes, chest pain, or unexplained change in exercise tolerance.
- Review of all current medications including prescription, over-the-counter preparations, and health supplements.
- Careful evaluation for a family history of sudden death, serious rhythm abnormalities, heart muscle disorders (cardiomyopathy), or Marfan's syndrome.
- A physical exam, including assessment of blood pressure and heart rhythm.
- An ECG to identify or rule out heart problems. The electrocardiogram should be read by a pediatric cardiologist or a doctor with expertise in reading pediatric ECGs.
- Referral to a pediatric cardiologist if the pretreatment evaluation shows cause for concern.
"We are not saying that if all these things can't be done, kids shouldn't be put on medication," Vetter says. "A child who lives in rural Kentucky may not have access to a pediatric ECG. We are going to have to figure out how to address the access issue."
Furthermore, even if heart disease is identified, treatment may still be used with careful monitoring. "It is reasonable to use stimulants with caution in patients with known congenital heart disease and/or arrhythmias, if these patients are stable and under the care of a pediatric cardiologist," the panel notes.