Abstract:Introduction:
The prevalence of attention deficit/hyperactivity disorder in the general population is common and is now diagnosed in 4%–12% of children. Children with CHD have been shown to be at increased risk for attention deficit/hyperactivity disorder. Case reports have led to concern regarding the use of attention deficit/hyperactivity disorder medications in children with underlying CHD. We hypothesised that medical therapy for patients with CHD and attention deficit/hyperactivity disorder is safe.
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“…The retrospective cohort study by Pierick et al 3 . is the largest and most recent study, which looked at adverse cardiovascular events in CHD patients on stimulant medications.…”
Section: Commentary and Critical Appraisalmentioning
confidence: 99%
“…1 However, there have been concerns of sudden death with stimulant use based on the 2006 FDA black box warning after 11 sudden deaths were reported in paediatric patients taking methylphenidate from 1992 to 2005. 9,17 Despite the cardiovascular adverse events, 3,5,6,8,11,12 stimulant medications remain the major measure to improve ADHD symptoms thereby improving quality of life. 2,16 A literature search was performed to investigate the safety of stimulant medications in paediatric patients with CHD.…”
Section: Commentary and Critical Appraisalmentioning
confidence: 99%
“…The retrospective cohort study by Pierick et al 3 is the largest and most recent study, which looked at adverse cardiovascular events in CHD patients on stimulant medications. The study found that one patient (prevalence rate 0.12%) with a preexisting supraventricular tachycardia experienced worsening symptoms while on stimulant therapy.…”
Section: Stimulant Medications In Congenital Cardiac Disease Paediatr...mentioning
confidence: 99%
“…The above studies [2][3][4][5][6] were all from cardiac specialist centres which included input from a cardiologist for commencement of stimulant medication.…”
Section: Stimulant Medications In Congenital Cardiac Disease Paediatr...mentioning
Aim
To review current literature regarding the safety of stimulant medications for treatment of attention deficit hyperactivity disorder in paediatric congenital heart disease (CHD) patients.
Methods
Embase, MEDLINE complete, CINAHL complete and Psychology and Behavioural Sciences Collection were searched for relevant articles from January 1980 to July 2022.
Results
One hundred and three articles were identified during the initial search after removal of duplicates. Thirty‐five articles were selected for review and 11 were included as relevant to the clinical question.
Conclusions
Stimulant medications are safe in patients with underlying CHD. In mild congenital cardiac conditions (ventricular septal defect, atrial septal defect and isolated semilunar valve disease), paediatricians can safely initiate stimulant therapy. With complex CHD cases, cardiology opinion is recommended prior to starting stimulants.
“…The retrospective cohort study by Pierick et al 3 . is the largest and most recent study, which looked at adverse cardiovascular events in CHD patients on stimulant medications.…”
Section: Commentary and Critical Appraisalmentioning
confidence: 99%
“…1 However, there have been concerns of sudden death with stimulant use based on the 2006 FDA black box warning after 11 sudden deaths were reported in paediatric patients taking methylphenidate from 1992 to 2005. 9,17 Despite the cardiovascular adverse events, 3,5,6,8,11,12 stimulant medications remain the major measure to improve ADHD symptoms thereby improving quality of life. 2,16 A literature search was performed to investigate the safety of stimulant medications in paediatric patients with CHD.…”
Section: Commentary and Critical Appraisalmentioning
confidence: 99%
“…The retrospective cohort study by Pierick et al 3 is the largest and most recent study, which looked at adverse cardiovascular events in CHD patients on stimulant medications. The study found that one patient (prevalence rate 0.12%) with a preexisting supraventricular tachycardia experienced worsening symptoms while on stimulant therapy.…”
Section: Stimulant Medications In Congenital Cardiac Disease Paediatr...mentioning
confidence: 99%
“…The above studies [2][3][4][5][6] were all from cardiac specialist centres which included input from a cardiologist for commencement of stimulant medication.…”
Section: Stimulant Medications In Congenital Cardiac Disease Paediatr...mentioning
Aim
To review current literature regarding the safety of stimulant medications for treatment of attention deficit hyperactivity disorder in paediatric congenital heart disease (CHD) patients.
Methods
Embase, MEDLINE complete, CINAHL complete and Psychology and Behavioural Sciences Collection were searched for relevant articles from January 1980 to July 2022.
Results
One hundred and three articles were identified during the initial search after removal of duplicates. Thirty‐five articles were selected for review and 11 were included as relevant to the clinical question.
Conclusions
Stimulant medications are safe in patients with underlying CHD. In mild congenital cardiac conditions (ventricular septal defect, atrial septal defect and isolated semilunar valve disease), paediatricians can safely initiate stimulant therapy. With complex CHD cases, cardiology opinion is recommended prior to starting stimulants.
“…Thus, greater activity within the DMN when individuals are at rest is thought to be reflective of difficulties in switching from internal to external thoughts [58]. In participants with CHD, this may reflect their cognitive and attentional dysfunction in daily life [59][60][61], as they may experience difficulties switching from internal to external stimulation. However, considering that we have not evaluated attention and hyperactivity, this hypothesis remains speculative.…”
Congenital heart disease (CHD) has been associated with structural brain growth and long-term developmental impairments, including deficits in learning, memory, and executive functions. Altered functional connectivity has been shown to be altered in neonates born with CHD; however, it is unclear if these early life alterations are also present during adulthood. Therefore, this study aimed to compare resting state functional connectivity networks associated with executive function deficits between youth (16 to 24 years old) with complex CHD (mean age = 20.13; SD = 2.35) who underwent open-heart surgery during infancy and age- and sex-matched controls (mean age = 20.41; SD = 2.05). Using the Behavior Rating Inventory of Executive Function–Adult Version questionnaire, we found that participants with CHD presented with poorer performance on the inhibit, initiate, emotional control, working memory, self-monitor, and organization of materials clinical scales than healthy controls. We then compared the resting state networks theoretically corresponding to these impaired functions, namely the default mode, dorsal attention, fronto-parietal, fronto-orbital, and amygdalar networks, between the two groups. Participants with CHD presented with decreased functional connectivity between the fronto-orbital cortex and the hippocampal regions and between the amygdala and the frontal pole. Increased functional connectivity was observed within the default mode network, the dorsal attention network, and the fronto-parietal network. Overall, our results suggest that youth with CHD present with disrupted resting state functional connectivity in widespread networks and regions associated with altered executive functioning.
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