Cardiac risk assessment before the use of stimulant medications in children and youth Flashcards
How many school aged children have ADHD?
3-7%
What are some challenges facing children with ADHD?
- School difficulties
- Lower self-esteem
- Family stress
- Psychiatric comorbidities
- Poor social skills or social isolation
- Poor sibling relationships
- Poor peer relatonships
What are some risks for adolescents with ADHD?
- School failure
- Poor social relationships
- MVC
- Delinquency
- Poor vocational outcomes
- Increased experimentation with tobacco, alcohol, drugs, and sex
- Double the risk for psychoactive substance abuse
- Speed citation and traffic violations
What are the risk of ADHD in structural congenital heart disease?
Increased risk of ADHD (30% of survivors of CHD) and can benefit from ADHD therapies.
What are some rhythm disorders in children?
- long and short QT syndrome
- Arrhythmogenic RV cardiomyopathy
- Brugada syndrome
- WPW syndrome
- Catecholaminergic polymorphic ventricular tachycardia
What are some cardiomyopathies in children?
Hypertrophic
Dilated
What is the rate of sudden death in children and youth?
- 3-8.5 per 100 000 patient years
1. 2-1.3 per 100 000 patient years
What is the rate of sudden death in children with heart disease?
90 per 100 000 patient years
Most common in TOF and d-TGA particularly after the Mustard or Senning procedures
What is the risk of death from all causes in children with ADHD?
58.4 per 100 000 patient years
What is the risk of sudden death in children with ADHD on methylphenidate, atomoxetine or amphetamines?
0.2-0.5 per 100 000 patient years
Same as the general population
What are screening questions for potential cardiac risk factors?
- SOBOE in the absence of alternative explanation
- Poor exercise tolerance in the absence of alternative explanation
- Fainting or seizures with exercise, startle, or fright
- Palpitations brought on by exercise
- Family history of sudden or unexplained death incld. SIDS, unexplained drowning or unexplained MVC (in 1st or 2nd degree relatives)
- Personal or family history (in 1st or 2nd degree relatives) of non-ischemic heart disease
- Long QT syndrome or other familial arrhythmias
- Cardiomyopathy
- Heart transplant
- Pulmonary hypertension
- Unexplained motor vehicle collisions or drowning
- Implantable defibrillator
- Hypertension
- Organic murmur present
- Sternotomy incision
- Other abnormal cardiac findings
Are routine ECG recommended as screening before initiating treatment for ADHD?
No. It is not supported by evidence and is not recommended.
Should a cardiologist be consulted in an ADHD patient without known heart disease?
No
Should a cardiologist be consulted in an ADHD patient with known heart disease?
Ultimate treatment decision should be made in consensus with their cardiologist but should primarily be made by the physician with expertise in ADHD as there is little evidence medications increase the risk of sudden death.
Should a cardiologist be consulted in an ADHD patient with suspected heart disease or identified risk factors for sudden death?
Yes, but that is unrelated to their ADHD
