ADHD Drugs and Heart Monitoring

The American Heart Association (AHA) has released April 2008 recommendations for monitoring the hearts of all children taking stimulant drugs, such as those used to treat ADHD. Parents may also want to learn about other options for managing ADHD.

We know that these medicines tend to increase the blood pressure of children by three or four points and the heart rate by one or two beats per minute. This has been considered safe for most kids, but potentially very serious for some with underlying heart problems. Since February 2007 the FDA has required that medications used to treat ADHD include a warning about their use in children with heart problems.

The AHA now recommends that physicians specifically check for these problems before starting ADHD medicines, in case they haven’t been diagnosed, and then take steps to recheck at every follow up while the child is still on the medicines. Pediatricians have already been doing many of these things, but not all of them. The biggest change is the recommendation that children have an electrocardiogram (ECG) before starting the medication, and again if the child develops cardiac symptoms, turns 12 years old, or has a change in family history while still on the medicines. A problem seen on the ECG does not mean skipping the medicine, but does mean that a cardiologist should be consulted about whether to start or continue.

Other recommendations include listening to the heart, checking the pulse and blood pressure, and asking a number of key questions (see below) before starting the medicines, again 30 to 90 days after starting, and again every 6 to 12 months for as long as the child is taking the medicines. Again, a problem here does not mean skipping the medicine, but does mean that a cardiologist should be consulted about whether to start or continue. With any medicine it is wise to weigh the risks and benefits of taking the medicine against the risks and benefits of not taking it.

These recommendations are reminders of the strength of ADHD medicines, and underscore the value of efforts to prevent ADHD and to learn about other ways to manage it where practical – including improving diet, exercise, and sleep.

Key questions to consider about the child should include:

• History of fainting or dizziness (particularly with exercise).
• Seizures.
• Rheumatic fever.
• Chest pain or shortness of breath with exercise.
• Unexplained, noticeable change in exercise tolerance.
• Palpitations, increased heart rate, or extra or skipped heart beats.
• History of high blood pressure.
• History of heart murmur (other than innocent or functional murmur) or history of other heart problems.
• History of viral illness with chest pains or palpitations.
• Current medications (prescribed and over the counter).
• Health supplements (non-prescribed).

The family history should include questions about any of the following in the family:

• Sudden or unexplained death in someone young.
• Sudden Cardiac Death or “heart attack” in family members under 35 years of age.
• Sudden death during exercise.
• Heart rhythm problems.
• Cardiomyopathy
• Significant ECG abnormalities
• Event requiring resuscitation in young members (under 35 years of age), including fainting requiring resuscitation.
• Anyone with Marfan syndrome.

Vetter VL, Elia J, Erickson C, Berger S, Blum N, Uzark K, Webb CL. 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. 2008 DOI: 10.1161/CIRCULATIONAHA.107.189473