Stimulant in young pt with asymptomatic mitral Regurgitation

[liquidshadow22]

Thoughts on managing this? Obviously best option would be get a Cardiology consultation, but curious on if there is a concrete data on this? Couldn't find much with a pubmed search.

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[clausewitz2]

Thoughts on managing this? Obviously best option would be get a Cardiology consultation, but curious on if there is a concrete data on this? Couldn't find much with a pubmed search.

Outside of frank arrhythmia I have never ever met a cardiologist who gave a single f**k about someone being on therapeutic doses of stimulants.

 

[whopper]

This is one of those things that ticks me off with specialists. I get the same thing with sleep disorders. You got a guy who has a problem such as a heart issue but he really has ADHD. So you send him to the cardiologist and the cardiologist gives pretty much no guidance.

I've had the same thing with sleep specialists with several of them telling me the only thing they really treat is OSA. That's it. So all that training all it comes down to is OSA? WTF? What was the point in memorizing all those other sleep disorders if that's all you do? If the patient has OSA they treat it otherwise they just give them any old sleep med. I have located a good sleep doctor in my locality but this is after several failures.

Okay I have seen some cardiologists (and sleep doctors) be more investigative but that batch is rare. When you find one you stick with that one. I had a cardiologist put a Holter-monitor on a patient while the patient was on a stimulant. That's going the extra mile, and it went to a degree where the cardiologist and I in agreement both documented that we did everything within the standard, and that the patient knew the risks, and opted for a stimulant knowing the cardiac risks despite that he had cardiac history.

Either that or you tell the patient "I'm not giving you any stimulant until we find a cardiologist who will look into your case." As for non-stimulants Atomoxetine can cause cardiac problems too. Wellbutrin too but not as much.

 

[TheTravelingShrink]

I second getting a cardiology consultation. While the mild increases in blood pressure, heart rate, etc, are unlikely to significantly increase risk for asymptomatic, stable mitral regurgitation - and the benefit of treating impulsivity (if present in combined or impulsive ADHD) may in itself decrease mortality - it is worth having a specialist provide a blessing for legal protection. A stimulant is vastly superior to atomoxetine or Wellbutrin in treating ADHD.

 

[SourceOfDenial]

I second getting a cardiology consultation. While the mild increases in blood pressure, heart rate, etc, are unlikely to significantly increase risk for asymptomatic, stable mitral regurgitation - and the benefit of treating impulsivity (if present in combined or impulsive ADHD) may in itself decrease mortality - it is worth having a specialist provide a blessing for legal protection. A stimulant is vastly superior to atomoxetine or Wellbutrin in treating ADHD.

I like this as a response to impulsivity: Rejecting impulsivity as a psychological construct: A theoretical, empirical, and sociocultural argument - PubMed

Saying a stimulant may decrease mortality decades in the future by reducing impulsivity seems like a bridge too far.

 

[calvnandhobbs68]

I like this as a response to impulsivity: Rejecting impulsivity as a psychological construct: A theoretical, empirical, and sociocultural argument - PubMed

Saying a stimulant may decrease mortality decades in the future by reducing impulsivity seems like a bridge too far.

It may decrease risk of serious injury and morality much sooner than that actually.

Serious transport accidents in adults with ADHD, and the effect of medication: A population based study - PMC

Studies have shown that Attention-deficit/hyperactivity disorder (ADHD) is associated with transport accidents, but the magnitude of the association remains unclear. Importantly, it is also unclear whether ADHD medication reduces this risk. First, ...

www.ncbi.nlm.nih.gov

Also that paper is a bit of a slog. It was also published like a week ago lol so idk how long you've been using it as a response to the term "impulsivity". I get it, they feel like impulsivity is too much of an umbrella term and would rather break it down into smaller constructs. Probably what most people mean by "impulsivity" is a combo of risk sensitivity + response inhibition. But man what a grind to get to Table 3.

 

[TheTravelingShrink]

Exactly what was said above - impulsivity is a known risk for vehicle accidents and other accidents, not to mention the known link between ADHD and substance abuse, which can have more immediate and long term ramifications.