ADHD children with heart disease on stimulant medication ……and the need for cardiac monitoring

National ADHD day is celebrated on the 14th September, and the Heart and Stroke Foundation SA would like to raise awareness about the need for cardiac monitoring of ADHD children and adolescents with heart disease who are being treated with stimulant medication.

Why is cardiac monitoring necessary?

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioural disorder in childhood and stimulant therapy may be an important component of the treatment plan for many of these children. Over the past ten years many concerns have been raised about the negative effects of these drugs. Although stimulant therapies are usually not harmful in children with healthy hearts, they may cause dangerous side effects in children with heart disease. Recent findings show that sudden cardiac death or death from heart rhythm disturbances have been reported in children with congenital or acquired heart disease.

As there is no universally applied cardiac screening for children for such heart conditions, it is important that physicians and parents ensure that children and adolescents receiving stimulant drugs are aware of any possible underlying heart problems.

What cardiac monitoring is recommended?

A cardiac evaluation and monitoring is recommended for ADHD children who are being considered for stimulant medication and those already on stimulants, but who have not previously been evaluated. The patient assessment should include a complete family medical history to determine possible heart problems.

ADHD children or adolescents already receiving or about to start stimulant treatment should undergo a physical examination checking for abnormal heart sounds, high blood pressure, rapid or irregular heartbeat or possible symptoms of Marfan syndrome (an inherited connective tissue disorder that can affect the heart).

An ECG may also be considered as part of the evaluation, to check for irregularities in heart rhythm that would otherwise not have been picked up in the physical examination. However, this is not mandatory – the child’s physician is the best person to decide whether there is a need for an ECG.

For ADHD patients with known congenital heart disease and/or arrhythmias, ADHD medications may be used provided they are stable, carefully monitored and ideally under the care of a paediatric cardiologist.

What is the bottom line?

Before starting a child or adolescent on stimulant therapy for ADHD, it is advisable that a physician or paediatrician checks for possible heart conditions and that they are controlled and monitored closely if detected.

Written by Erika Ketterer, Registered Dietitian at the Heart and Stroke Foundation, S.A.

For FREE heart smart nutritional advice from registered dietitians, call the Heart Mark Diet Line on 0860 223 222 or email heart@heartfoundation.co.za