Posted By CCF cardio MD - SK on September 20, 1997 at 13:11:52:
In Reply to: Ritalin and heart attack posted by Regina Barnum on September 19, 1997 at 14:40:59:
: Two weeks ago my 31 year old son had a heart attack. An angiogram showed
little problem with plaque (20%), and he is otherwise in perfect health as
he is a student, active outdoorsman, works out daily, and has never been
sick. Blood pressure is perfect. The only possible outside cause may be
his use of Ritalin for ADD. He is off the drug at present and unable to
focus in classes, which only adds to the depression he is experincing. Do
you know of any links or incidents of the use of this drug and the
occurrence of heart attack? He is on coumadin and another drug in case the
cause of the attack was a spasm. This was a massive attack in which he had
to be defibrillated 3 times, and, naturally, he is more than concerned it
will happen again.
Thank you for any help you are able to give.
Dear Regina Barnum,
Heart attack at the age of 31 years is definitely not a common occurrence but, 20% stenosis with a plaque is not an uncommon finding after an acute heart attack. Actually about one third of the patients who are catheterized immediately after an heart attack have this kind of minor stenosis in their coronary arteries. The mechanism of heart attack is the total blockage of the artery with a clot which formed on the 20% stenosis. So I agree that is very important to find out the cause of premature heart attack.
It is not reported in the literature that methylphenidate (ritalin) leads to heart atttack. There are some reports suggesting its effects on heart muscle cells but that does not lead to a heart attack.
What is the cause of this early problem and can we do something about it?? It is a very important question. At times we can identify some factors that would explain this (these factors could range from cholesterol to blood levels of some clotting related factors to the study of some genes). In some of these situations we could do something about it. Moreover, one important thing to consider is that sometimes cardiac catheterization can miss or underestimate a significant blockage. I think that these possibilities should be closely examined.
I hope I have clarified some of the questions you had. If you are seeking a second opinion or further evaluation, an appointment with one of our cardiologists specializing in coronary artery disease and cardiac prevention can be arranged by calling the Cleveland Clinic by calling (216) 444-6697.
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