The American Heart Association (AHA) has just issued a statement that advises using an electrocardiogram (ECG) before beginning treatment using stimulant drugs in children with attention deficit hyperactivity disorder (ADHD) whenever possible.  The full statement is available in the online journal Circulation: Journal of the American Heart Association.

Concerns arose as early as 1999 when the potential for cardiovascular events was noted in children taking tricyclic antidepressants and other psychotropic drugs and stimulants.  ECG monitoring was advised at that time for the psychotropic drugs but no such monitoring for stimulant intake was recommended.

Since that time, numerous studies have indicated that stimulants commonly prescribed for children with ADHD can elevate blood pressure and speed up heart rate.  Most children taking stimulants will have no problem but there is a small group of children, estimated to be about 2%, who have undetected cardiac conditions that can lead to cardiovascular events when stimulants are taken.  One major concern is for sudden cardiac death (SCD), which occurs when an erratic heart rhythm cannot pump blood effectively throughout the body.

The AHA recommends adding an ECG to the standard methods of diagnosis when considering prescribing stimulants to children with ADHD, in order to detect any as-yet-unknown heart conditions that could lead to cardiac events.  The ECGs are advised periodically throughout the time the child is taking the stimulant.  Doing so at intervals of one to three months after beginning the stimulant and again every six to 12 months after that is recommended.  Children already taking stimulants for ADHD are advised to continue medication as usual but undergo an ECG as soon as possible, especially if they began the stimulant before reaching the age of 12.

Many children’s heart conditions do not present symptoms but there is a link between children with ADHD and cardiac conditions.  Pediatric cardiac patients are 33% to 42% more at risk of ADHD than children with healthy hearts.  ADHD medications were prescribed for as many as 2.5 million American children in 2003.  The disorder is believed to affect between 4% and 12% of all school-aged children in the US.

Because it is difficult to determine the exact number of children experiencing SCD associated with drug treatment, the AHA recommends a national database for this information.  Reporting the incidence of SCD is currently voluntary and reported only to local authorities.