ADHD Drugs: Heart Screen Recommended
American Heart Association Calls for Electrocardiograms Before Kids Take ADHD Drugs
WebMD News Archive
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
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
- 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
- A physical exam, including assessment of blood pressure and heart
- 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
- 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.