Heart tests urged before children take ADHD drugs

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Attention-deficit disorder medications have side effects that could raise blood pressure and heart rate: experts
Sharon Kirkey, The Ottawa Citizen
Published: Tuesday, April 22, 2008
Every child prescribed Ritalin or other ADHD drugs should first get heart tests to check for conditions that could put them at risk of sudden unexpected death, U.S. experts are recommending.
The drugs --among the most widely-prescribed pills to Canadian children -- can increase blood pressure and heart rate, side effects that could be dangerous for children with known heart problems or heart defects.
But some children can have undiagnosed heart conditions without showing any symptoms.



"They might get a little bit dizzy when they exercise or they might feel fluttering heartbeats or a near fainting spell that they don't bother to worry about," says Dr. Catherine Webb, professor of pediatrics at Northwestern University Feinberg School of Medicine in Chicago and chair of the council on cardiovascular disease in the young at the American Heart Association.
Now, the heart association is recommending all children get an electrocardiogram (ECG) before they're put on Ritalin or other brain stimulants for attention deficit hyperactivity disorder. This would raise the standard of care required in Canada, where doctors routinely check a child's family history for signs of heart problems, but don't send all kids for an ECG.
It's the first time routine heart screening is being recommended for children.
"We recognize that the ECG cannot identify all children with these conditions but will increase the possibility," reads the new scientific statement published this week in the journal Circulation. An ECG measures the heart's electrical activity and can often spot heart rhythm abnormalities that could lead to sudden cardiac death.
"There's been a big flap about it in the cardiology community and we wanted to help people do a more standardized approach to this," says dr. Webb, one of the authors.
But it's not known whether the risk of sudden cardiac death for those on stimulants is higher than for people in the general population, or if screening with an ECG can reduce the risk.
Canadian retail drug stores filled more than two million prescriptions for ADHD drugs in 2007, according to prescription drug tracking firm IMS Health Canada.
ADHD is the most frequently diagnosed neurobehavioural disorder of childhood and it may be even more common in children with heart conditions. One study of children with heart disease found 45 per cent had abnormal attention, and 39 per cent had abnormal hyperactivity scores.
Doctors at the University of Pennsylvania School of Medicine in Philadelphia reported last year that up to two per cent of healthy school-aged children had potentially serious undiagnosed heart conditions picked up by an ECG.
The actual risk of ADHD drugs to kids with congenital heart disease isn't known, but all stimulate the heart and blood vessels. Those side effects have been thought to be "clinically insignificant" for most children with ADHD, but "there may be a potential for severe adverse events in some children with certain forms of congenital heart disease or arrhythmias with a predisposition for sudden cardiac arrest," the statement says.

But Dr. Attila Turgay, psychiatrist and director of the Toronto ADHD clinic, says that until Health Canada and Canadian medical groups critically review the recommendation, "I think that parents should not be scared or worried."
"We don't have really strong evidence that ADHD medications cause sudden death syndrome,"says Dr. Turgay, one of the authors of ADHD practice guidelines published this year by the Canadian ADHD Resource Alliance.
"There is a lot of over-alerting going on against highly reliable medications."

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