ECG Urged Before Giving ADHD Drugs

By Henry Bernstein, D.O.
Content provided by the Faculty of the Harvard Medical School

Children should be tested for heart problems before being treated with drugs such as Ritalin, the American Heart Association (AHA) says. The new guidance applies to children with attention-deficit hyperactivity disorder (ADHD). Drugs used to treat ADHD can increase blood pressure. They also can speed up the heart. In someone with a heart condition, this could cause the heart to stop. The AHA says kids should have an exam and an electrocardiogram before drugs are prescribed. The Associated Press wrote about the statement April 22. It was published in the journal Circulation.

What Is the Doctor's Reaction?

The American Heart Association (AHA) now recommends that children and teenagers be screened for heart problems after they have been diagnosed with attention-deficit hyperactivity disorder (ADHD). If possible, this should occur before a stimulant medicine is prescribed, the AHA says.

How come? The AHA has updated its Guidelines for Pediatric Patients with ADHD because of new concerns. Stimulant medicines could prove to be riskier in children with underlying heart problems. These problems are not always known before a patient starts to use these medicines.

More and more children and teens are being diagnosed with and treated for ADHD. In 2004, U.S. doctors prescribed stimulant medicines for 2.5 million children. Besides their effects on behavior, stimulants have known effects on children's hearts. They increase blood pressure and heart rate. Usually, this does not affect the children's health.

Between 1999 and 2004, there were 19 reported cases of sudden cardiac death in children taking stimulant medicines for ADHD. Another 26 children had non-fatal, but very important, cardiovascular events. These included stroke, cardiac arrest and rapid heartbeat.

These numbers may seem small compared with the overall number of patients taking medicine for ADHD. However, until we have more data, it makes sense to be on the safe side.

What Changes Can I Make Now?

  1. Know your child's (and your family's) medical history. Keep track of all health problems. Talk with the people in your family about their illnesses and medical conditions. Ask them about family members who have died in the past. Medical problems often run in families. It helps to know if you or your children are at any special risk.

  2. Establish a medical home. Form a long-lasting relationship with a health care professional. This can help ensure that your child receives the best possible care over time. If you move, make sure all of your family's medical records are sent to your new doctors. This information allows your child's new doctor to keep track of any potential problems.

  3. If your child has ADHD, talk with his or her doctor about heart health and screening. Tell your doctor about any concerns you have. If your child has any cardiac problems, let the doctor know right away. Examples might include a fast heartbeat (palpitations) or fainting. Also tell the doctor if there is a family history of sudden cardiac death. An electrocardiogram (ECG) would be a valuable screening test now, even if your child has been on stimulants for a while.

This is what to expect during an office visit about the use of stimulant medicines:

  • A medical history review — This will include any relatives who experienced sudden cardiac death and any symptoms in your child that could suggest a heart problem. In addition, the doctor will review your child's medical records to be sure that heart rate and blood pressure have been normal. He or she will record the names of all prescription and over-the counter drugs your child takes.

  • A physical exam — The doctor will check your child's heart, including the heart rate and blood pressure. The doctor also will check for any of the features of Marfan syndrome. This is a connective tissue disorder that can cause serious heart problems.

  • An electrocardiogram (ECG) to find heart abnormalities — An ECG is a painless, risk-free procedure. Electrodes are placed on the arms, legs and chest to measure the heart's electrical activity.

If a heart problem is noticed, the doctor will decide whether it is still safe to prescribe a stimulant medicine. The AHA now recommends follow-up care with a pediatric heart specialist (cardiologist) for these children.

What Can I Expect Looking to the Future?

Right now, we do not know for sure what the true rate of sudden cardiac death is among children who take stimulants.

In the future, there will likely be a national registry to keep track of cases of sudden cardiac death. This will help doctors to know more about:

  • The risks of using stimulant medicines in children and teens with ADHD

  • How effective it is to use universal screening and ECG testing

Last Annual Review Date: 2008-04-22T00:00:00-06:00 Copyright: © Harvard Health Publications