Should Your ADHD Child See a Cardiologist Before Taking Medications?
The American Heart Association recently recommended an ECG (electrocardiogram, sometimes mistakenly called an EKG) before a child is started on a stimulant medication for ADHD. Approximately two years ago, the FDA recommended a black box warning for patients taking AD/HD medications regarding the potential for cardiovascular events in patients with serious, pre-existing structural cardiac abnormalities.
Should parents of children with AD/HD be alarmed by these recommendations? The answer is no. Medications for AD/HD are considered safe when used in appropriate doses used to treat AD/HD in children, adolescents, and adults without serious cardiovascular disease. The incidence of serious cardiovascular events in children taking medications for AD/HD is very low, and is similar to the incidence of cardiovascular events in children not taking medications.
The above recommendations were not made to limit the use of AD/HD medications, but to help identify children with pre-existing heart disease who may be at risk when taking such medications.
Your child's doctor should take a "Heart History" prior to prescribing AD/HD medications, and your child should be seen regularly (approximately every three months) to monitor their blood pressure and heart rate. A heart history should include:
Your child's doctor should do a physical examination looking for an abnormal heart murmur and other cardiovascular abnormalities, features of Marfan's syndrome (an inherited connective tissue disorder), and measurement of blood pressure and heart rate.
The American Heart Association is also recommending that an ECG be done prior to starting a medication for AD/HD, and if abnormal, a referral to a pediatric cardiologist. Not all doctors will order an ECG if the heart history and physical examination are normal, without evidence of heart disease, because the potential incidence of cardiac toxicity from AD/HD medications is so low. Even the American Heart Association admits that there have been no large studies proving that AD/HD medications have caused sudden cardiac events.
In summary, although recent recommendations are not cause for alarm, taking a heart history, doing a physical examination, and monitoring children, adolescents, and adults on medications used to treat AD/HD should be standard practice. No mother and child should walk into a doctor's office with a rating scale completed by the child's teacher, and walk out 15 minutes later with a prescription. An evaluation for AD/HD should be comprehensive, and should include a comprehensive history of possible medical problems, emotional problems, and problems commonly co-existing with AD/HD. A comprehensive evaluation should lead to a comprehensive treatment plan, with a specific treatment for each problem identified.
Related Topics:
Technorati Tags: ADHD, heart screening, FDA, stimulant medications, healthy children
Should parents of children with AD/HD be alarmed by these recommendations? The answer is no. Medications for AD/HD are considered safe when used in appropriate doses used to treat AD/HD in children, adolescents, and adults without serious cardiovascular disease. The incidence of serious cardiovascular events in children taking medications for AD/HD is very low, and is similar to the incidence of cardiovascular events in children not taking medications.
The above recommendations were not made to limit the use of AD/HD medications, but to help identify children with pre-existing heart disease who may be at risk when taking such medications.
Your child's doctor should take a "Heart History" prior to prescribing AD/HD medications, and your child should be seen regularly (approximately every three months) to monitor their blood pressure and heart rate. A heart history should include:
- A family history of a sudden, unexplained death at an early age; a heart attack in relatives younger than 35; a history of cardiac arrhythmias; and a family history of any cardiac "syndrome."
- A history in the child of fainting or dizziness (particularly with exercise); a history of any chest discomfort, chest pain, or shortness of breath with exercise; a change in exercise tolerance; a history of palpitations, increased heart rate, extra beats or skipped beats, high blood pressure, or a significant heart murmur.
- A history of prescribed medications, over-the-counter medications, and "natural" supplements taken by the child
Your child's doctor should do a physical examination looking for an abnormal heart murmur and other cardiovascular abnormalities, features of Marfan's syndrome (an inherited connective tissue disorder), and measurement of blood pressure and heart rate.
The American Heart Association is also recommending that an ECG be done prior to starting a medication for AD/HD, and if abnormal, a referral to a pediatric cardiologist. Not all doctors will order an ECG if the heart history and physical examination are normal, without evidence of heart disease, because the potential incidence of cardiac toxicity from AD/HD medications is so low. Even the American Heart Association admits that there have been no large studies proving that AD/HD medications have caused sudden cardiac events.
In summary, although recent recommendations are not cause for alarm, taking a heart history, doing a physical examination, and monitoring children, adolescents, and adults on medications used to treat AD/HD should be standard practice. No mother and child should walk into a doctor's office with a rating scale completed by the child's teacher, and walk out 15 minutes later with a prescription. An evaluation for AD/HD should be comprehensive, and should include a comprehensive history of possible medical problems, emotional problems, and problems commonly co-existing with AD/HD. A comprehensive evaluation should lead to a comprehensive treatment plan, with a specific treatment for each problem identified.
Related Topics:
Technorati Tags: ADHD, heart screening, FDA, stimulant medications, healthy children
