stimulant medications for ADHD effects on BAV

[shell2961]

Dr. Boris,

I am a mom and pediatric nurse who is very concerned about her 12 y.o. son. He has been on Straterra for the last 5 years. During that time he has been diagnosed with bicuspid aortic valve. After reading all the latest research I am concerned about switching him to a stimulant to treat his ADHD. We are a military family and have had to switch our pediatric cardiologist with each move and thus get some conflicting info about the effects of stimulants. My son has tachycardia on the straterra with heartrates 90-100. Please help me I am very concerned.

Ryan's mom.

[Jeffrey R Boris, M.D.]

Dear Ryan’s mom,

Having previously been a pediatric cardiologist in the US Air Force for 7 years, I am very familiar with your concerns regarding having frequent changes in both primary and specialty providers for you and your family.  It’s difficult to keep up with the changing information that you’re getting from the different providers as well as what you are finding in your own reading.  I do want to make a couple of comments about your research here, though.  First, Strattera is not actually considered a stimulant medication.  Thus, if his ADHD needs to be treated with a stimulant, then that would be a different medicine.  Second, although I haven’t evaluated your son and don’t know all the information about him, a heart rate of 90-100 at rest for a 12 year-old is actually not considered tachycardia.  The normal heart rate range for someone of his age is between 60 and 120 to 130, so this is not a problem.  

Third, and most importantly, if your son is started on a stimulant, the facts in the literature are that they do add a small amount of heart beats per minute to the resting heart rate and may add a couple of mmHg to the resting blood pressure, but it is likely not clinically significant.  That said, your primary care provider would have to monitor for both of these as side effects.  Otherwise, there is no good data to demonstrate that stimulants are associated with any other problems with the heart, including sudden cardiac death or hastening the complications of bicuspid aortic valve or other structural cardiac defects.  This is despite the article published one year ago last spring.  So that you know, bicuspid aortic valve can be complicated by aortic valve stenosis, insufficiency, and prolapse, as well as aortic root and ascending aortic dilation.  Your cardiologist would be watching for these things in your son’s routine follow-up evaluations.