The American Heart Association Proposes Cardiac Testing Before Prescribing Stimulants to Children with ADHD. It is "reasonable" to undertake cardiac testing when considering stimulant drug therapy for children with attention deficit/hyperactivity disorder, according to a scientific statement from the American Heart Association. The statement, published online in Circulation, cites concerns that stimulants (e.g. Ritalin, Adderall) may increase the risk for adverse events, including sudden cardiac death, in children with congenital heart disease. Accordingly, the AHA recommends that clinicians do the following before starting treatment:

* obtain a complete patient and family history, with careful attention to conditions such as cardiomyopathy and Marfan's syndrome;
* perform a physical exam to check for cardiovascular abnormalities including heart murmurs and hypertension;
* consider ordering an ECG
* arrange a consultation with a pediatric cardiologist if abnormalities are discovered during the above steps. The AHA concludes that:
* all children prescribed stimulants should be routinely monitored for cardiac symptoms;
* stimulants remain a reasonable option for children with stable heart disease, or those currently under a pediatric cardiologist's care;
* for children already on stimulants, physicians may want to take a complete history, review the physical exam, and order an ECG.

The American Academy of Pediatrics has recently suggested caution on implementation of EKG's for everyone taking stimulant medication. Targeting the high risk groups for selective EKG's based on a risk in family history or findings on physical exam should trigger further evaluation.