ADHD medication and ECGs

@sashh thank you. I’ll not worry then.

Each and every part of your heart has 'inherent rhythmicity', this means that if the conducting system doesn't work as it should the atria and ventricles can take over but at a lower rate than that initiated by the conducting system.

A RBBB on its own means a little bit of the conducting system is slow, on it's own it is fine.

If you had a normal ECG and you were on a treadmill and developed it, that is more of a problem because it indicated the conducting system is normal but there has been a blockage to the oxygen being supplied to the bundle branch block.

@Neurotic1000 ive got a right bundle branch block. It was picked up on an ecg at 17 (id been having chest pains so went to a&e) chest pains were totally unrelated, they told me about the ecg said your born with it, but never said I needed to see anyone, I’ve had other ecg’s since and they mention it every time but I’ve never had any follow up. It’s not something they told me was an issue. I’m 34 now.

Is your dh follow up for the RBBB due to his sisters sudden cardiac arrest?

Sorry I missed you have had a clear ECG. Your next steps sound good.

My understanding is that while it's absolutely sensible and a good idea to have an ECG before ADHD medication, it's basically a precaution, there is no actual indication that they are dangerous in that way, as in there are no recorded cases of illness or death caused by ADHD medication leading to heart issues. While it's been fairly recent that we've been using that medication in Europe, it's been used in the US since the 1960s or something like that. And still no heart related adverse events. Maybe some palpitations which again you'd take the person off the medication as a precaution (sensible). But no actual serious problems or harm caused. I'm happy to be corrected but this is what I understand to be the case.

I can't speak to the family history stuff because I don't know anything about that.

Very sensible approach IMHO.

Fingers crossed the echos show nothing abnormal.

Yes I'd say that regardless of the ADHD medicines that an echo might be a good idea with the family history.

However this really needs to be regular follow up, not just a once off... so you should really try approach your GP from this POV so they can refer you.

Exactly the same process for us.

Not a cardiologist in sight!

OK think of the heart as the boiler from your central heating system.

It has a pump that pumps hot water around the pipes, this is your heart pushing blood in to your arteries.

It also has an electrical system that controls the timing.

An ECG only shows the electrical system, a right bundle branch block, which doesn't mean the right side of the hear it means the first right branch of the electrical system as it comes out of the AV node.

An echo shows you the structures of the heart ie the 'pump'.

The ADHD medication can interfere with the electrical system, hence the ECG.

BUT it doesn't show the structure, which is usually the cause of sudden death in young people (under 35).

So for the ADHD meds, no you don't need an echo.

But an echo would tell you if the structures are normal.

It is possible to have a completely normal ECG whilst the heart isn't pumping at all. It's rare and you would have symptoms that would send you to the A and E.

I think concerta is like Elvanse, you don't have to take it all the time. My DD14 only takes her Elvanse on school days.

You have a choice. Either follow their advice and start, get the additional tests if the dose increases or get the test now.

Just wanted to suggest your son may be eligible for NHS cardiac screening including ECG and echo because of the young cardiac death in your family. Have you explored this? CRY (cardiac risk in the young) is a charity that deals with this, lots of information for families in your position. So sorry for your recent bereavement.

As others have said, the vast majority of ECGs are not reviewed by cardiologists and a doctor requesting a medication-related ECG will know what they are looking for. ADHD medication is not associated with increased cardiac risk so this would seem to be an extra precaution.

You are clearly not going to settle into this until you have covered all bases.

I'd get the additional test.

They will also monitor every few months his height, weight, blood pressure, appetite etc

Ask for a medication he doesn't have to take every day, just school days, like Elvanse.

If you can afford it I would go for the echo.

As I said it is a belt and braces approach and as your husband has had one that showed something.

I would not say it was needed for the meds, but for the same reason as your husband. This should be provided by the NHS but if you have the cash it will be quicker privately.

Sorry, I don't want to scare you. I just want you to be reassured.

I'm a nurse and can interpret ECG's.
My husband had to have one prior to starting on a new medication for epilepsy.
I quickly looked at it... said it was fine... the doctor done the same!

Sorry just read your update, if they think your child needs an echo for whatever reason, this is additional for ADHD meds so you should definitely be asking for a referral to the hospital and not have to pay privately.

So with a family history as you've described, the siblings of the aunt (you or your husband) should be referred to cardiology for further testing. This is really important.

Your child might also be able to be referred, it depends on the area. I'm really surprised the GP won't refer for an ECG, but you should check out https://www.c-r-y.org.uk/screening/#:~:text=CRY%20offers%20subsidised%20ECG%20screening,be%20read%20by%20a%20cardiologist. As they do subsided cardiac checks for young people so you could get an ECG there.

Hope that helps.