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American Heart Association Recommendation for
Children Taking Medications for ADHD |
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As of April 23, 2008, the American Heart
Association is now recommending that children with attention deficit
hyperactivity disorder (ADHD) should have an electrocardiogram (EKG) - before
starting treatment with stimulant drugs. The
The
Dr Victoria Vetter, a pediatric Cardiologist
at the University of Pennsylvania school of Medicine, who was head of the
committee who made the American Heart Association recommendation states “Our
intention is to provide the physician with some tools to help identify heart
conditions in children with ADHD, and help them make decisions about the use of
stimulant medications and the follow-up of children who take them.”
Vetter said “The goal is to allow treatment of ADHD, while attempting to
lower the cardiac risk of these products in susceptible children.” The
statement writing committee said its recommendations are not intended to limit
the appropriate use of stimulants in children with ADHD.
Studies have shown that stimulant medications like those used to treat
ADHD can increase heart rate and blood pressure. These side effects are insignificant
for most children with ADHD; however, they’re an important consideration
for children who have a heart condition. Certain heart conditions increase the
risk for sudden cardiac death (SCD), which occurs when the heart rhythm becomes
erratic and doesn’t pump blood through the body
Doctors usually use a physical exam and the patient and family history
to detect the risk for or presence of health problems before beginning new
treatments, including prescribing medication. But some of the cardiac conditions
associated with SCD may not be noticed in a routine physical exam. Many of
these conditions are subtle and do not result in symptoms or have symptoms that
are vague such as palpitations, fainting or chest pain.
That’s why the statement writing group recommends adding an EKG to
pre-treatment evaluations for children with ADHD. An EKG measures the
heart’s electrical activity and can often identify heart rhythm
abnormalities such as those that can lead to sudden cardiac death.
If heart problems are suspected after the evaluation, children should be
referred to a pediatric cardiologist. Once stimulant treatment begins, children
should have their heart health monitored periodically, with a blood pressure
check within one to three months, then again at routine follow-ups every six to
12 months.
“Children can have
undiagnosed heart conditions without showing symptoms,” Vetter said.
“Furthermore, a child’s body changes constantly, with some
conditions not appearing until adolescence.” If the initial EKG was taken before age
12 years, it may be useful to do a repeat EKG after the child is over age 12
years, the statement says.
The number of undiagnosed children with heart conditions is unknown as routine
heart screening is not performed, but Vetter said that a recent pilot study she
presented at the American Heart Association’s 2007 Scientific Session
indicated that up to 2 percent of healthy school aged children had potentially
serious undiagnosed cardiac conditions identified by an ECG.
“While we feel that an EKG is reasonable and helpful as a tool to
identify children with cardiac conditions that can lead to SCD, if, in the view
of their physician, a child requires immediate treatment with stimulant
medications, this recommendation is not meant to keep them from getting that
treatment,” said Vetter, who added that some children may not have access
to a pediatric cardiologist who can evaluate an ECG or perform a cardiology
consultation.
Although we do feel very comfortable with the safety of these medications,
until the