If children with attention deficit hyperactivity disorder underwent a standard evaluation to identify possible heart conditions before they began a stimulant medication, risk could be minimized for drug-related cardiac complications, according to an article published online April 21 by Circulation.

The American Heart Association released the statement on children and adolescents who receive stimulant drugs in an effort to improve care for the large number of young people who take stimulants to control symptoms of the disorder. In the United States, an estimated 2.5 million children take medication each year for the behavioral disorder. Stimulants are known to increase heart rate and blood pressure, and the advised screening program would identify children at higher risk for significant complications from the medication, including sudden cardiac death.

The first element in screening is a thorough personal and family history, looking for symptoms such as heart palpitations, syncope or near-syncopal episodes, chest pain, especially during or after exercise, or a sudden or recent change in exercise tolerance. Questions regarding family history include evidence of the same symptoms, as well as any case of early sudden cardiac death or conditions such as hypertrophic cardiomyopathy, long QT syndrome or other dysrhythmia, Marfan syndrome, or members with hypertension, heart murmur, or diagnosis of a cardiac condition.

Physical Examination should note blood pressure, heart rhythm, and any murmur. Signs of Marfan syndrome should be noted. The third standard element should be an electrocardiogram.

The authors of the report suggest a pediatric cardiology consultation if there are any significant findings on history, physical exam or electrocardiogram. The report also advises prescribing physicians to make sure children have their heart health monitored periodically.

The cardiologist who wrote the report specifically noted that it may be reasonable to use stimulants with caution in patients with known congenital heart disease and/or arrhythmias, if the patients are stable and under the care of a pediatric cardiologist.

"After ADHD is diagnosed, but before therapy with a stimulant or other medication is begun, we suggest that an electrocardiogram be added to the pre-treatment evaluation to increase the likelihood of identifying cardiac conditions that may place the child at risk for sudden death," said Victoria L. Vetter, MD, head of the statement writing committee and Professor of Pediatrics at the University of Pennsylvania School of Medicine.

Vetter also said doctors should evaluate children and adolescents already taking these medications if they were not evaluated when they started the treatment.

Vetter concluded, "Children can have undiagnosed heart conditions without showing symptoms. Furthermore, a child's body changes constantly, with some conditions not appearing until adolescence."