ADHD medication and ECGs

[Neurotic1000]

I am incredibly confused
The private doctor who did the assessment has requested I get a private ecg ( gp won’t do it as it’s for private medication ) but can she interpret the results well enough to confirm the medication would be safe?
DH thinks as she’s not a cardiologist that this is very risky - I just want to help DS get through school life 😢

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.

Exactly the same process for us.

Not a cardiologist in sight!

I completely understand your last post - thank you so much.
If I’m right you’re saying for the ADHD medication the echo isn’t required but considering what has happened an echo would be a good idea anyway which means we need to book one for our younger DD too in this case

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.

Yes I’m going to go to the GP and ask them to refer both children based on what happened.
Thr cardiologist who saw my DH said his children would only be seen if something definitive showed on his MRI but seeing as ecg and echo were abnormal I think I have reason to push

At least it’s seems we can start the medication he so desperately wants to now with the clear ecg

Very sensible approach IMHO.

Fingers crossed the echos show nothing abnormal.

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.

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

Thank you - I think I’ve got myself into a bit of a state because I don’t feel sure about the medication generally but he wants to try it very much 😢

@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?

Yes that’s the reason for DHs echo and MRI

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.

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