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ADHD Drugs: Heart Screen Recommended

American Heart Association Calls for Electrocardiograms Before Kids Take ADHD Drugs

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.

The AHA has also called for periodic cardiac evaluations of patients taking ADHD drugs. The guideline states that blood pressure and pulse should be evaluated during routine follow-up visits (every one to three months). The guideline also recommends that a repeat ECG be considered after the age of 12 if the initial treatment ECG was obtained before 12 years of age. Finally, patients currently taking stimulant medications who have not undergone ECG testing in the past should have an ECG performed.

Panel members also called for the establishment of a registry to track sudden cardiac deaths (SCD) in children, teens, and young adults.

"Such a registry, even if comprehensively maintained over a short period of time, would allow a more accurate understanding of many questions related to sudden cardiac death, including the potential association of stimulant drugs and SCD," Vetter and colleagues write.

WebMD contacted the Pharmaceutical Research and Manufacturers of America (PhRMA) about the AHA's new guidelines. In an email, PhRMA spokesman Jeff Trewhitt says that PhRMA's medical staff is still reviewing the guidelines.

Doctor's View

WebMD spoke with Robert H. Beekman, MD, chairman of the American Academy of Pediatrics' section on cardiology and cardiac surgery, about the AHA's new guidelines.

"The American Heart Association proposal is reasonable and represents the cautious opinion of a number of national experts," says Beekman, who works at Cincinnati Children's Hospital.

"There are concerns among some cardiologists, however, that widespread screening with electrocardiograms may generate quite a few false-positive findings, which could lead to a lot of parental concern and a lot of expense," Beekman says. "I think it will be critical after a period of time has passed for the American Heart Association to study the true impact of this new recommendation."

Electrocardiogram readings "vary considerably among normal children," Beekman explains. "What is normal is variable by age, by race, by gender -- and there are common false-positives that turn out to be misleading once somebody delves into them."

But Beekman notes that "in the face of a formal American Heart Association policy statement that's published and released to the lay public, it will be hard to not practice medicine in a fashion that's aligned with the policy."

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With additional reporting by Miranda Hitti.


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