Cardiac Workup: Has Your Primary Care Dr. requested cardiac clearance B4 RX?

[Anonymous]

Has your primary care physician screened you or requested a cardiac screening prior to prescribing ADHD meds? After reading about some of the ADHD (stimulant and non-stimulant) medications, I was curious for learning sake.

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[Anonymous]

No. But I had some issues earlier this year and thought it was my heart (I have a friend who is a cardiac rehab nurse who suggested it, and also another friend whose husband has had cardiac ablation procedures recently), so I did have a cardiac stress test done (the treadmill one). As it turned out, my asthma had worsened, I had stopped taking meds, and needed to go back on, and a different med. I still do have the problem from time to time but at least I am not worried about it.

I think it’s a good idea. But expensive for the testing, and it takes forever to get booked for tests at the hospital here. They also don’t confirm that your referral has been received, causing a lot of anxiety and searching for other options.

I know it’s a pain to have all the tests, but I think one needs to look at all aspects (including sleep quality, my broken record).

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[billd]

I echo fully what no-dop said. 150% behind all of that, maybe 151% even.

I was loosely diagnosed by my “primary doctor” or family doctor. #1 – I don’t think they can do a good enough job. i’d never stop with that, and I did not in my case.

He said he would ONLY give Stratterra because of “my advanced age” and the risks to heart health. I didn’t like that answer, and frankly I reacted not very well to strattera – it not only didn’t help me, it had side effects that were worse than the ADHD. So what does a family doc know about mental health anyway?

Very little, I find out.

So I go further, get a referral to the Behavioral Center where I went through an extensive interview process. she said yes, I was very ADHD, and was going to prescribe meds, but I was in the sleep study and getting diagnosed for sleep issues at the same time, so she deferred to the sleep doc. She did say, however, when I told her what my primary doc said “that’s bunk, we do this all the time, there’s no risk unless you already have a condition or are prone to it”. She totally disagreed with the family doc and said he was wrong.

So I went through the sleep study, and in the mean time, I had some issues with heart flutter, tight chest, very tired, breathless after a flight of stairs, etc.

So I went to the heart center. After all their poking, prodding, testing, blood, treadmill, 48 hour monitoring and so on – my heart is as healthy as a horse, it doesn’t work hard at all, low BP, slow pulse about 59-60 when awake, in the 40s when asleep. They said do not worry about my heart at all. My symptoms? Anxiety and ADD! LOL

So back to the ADHD doc, put on Adderall XR 20mg. Back to the sleep doc, she said that’s what she’d do for me for my sleep issues, too – but she’d give me even MORE!

So in the end, the sleep doc and the ADD doc BOTH said that what they would prescribe is SAFE unless I already have issues with heart. I for my own peace of mind got my heart checked, but am fine. Tests after 2 weeks of Adderall show my BP has NOT gone up one bit, and my heart rate is still as slow as ever.

now, that’s ME, that’s NOT YOU. If you feel uneasy, get tested, express your concerns to the specialist. Do NOT rely on a family doctor!

I’ve proven them wrong so many times over the years it’s pathetic. In fact, frankly, I could have had two malpractice suites over the last 10 years and probably handily won them both, but I’m not really that type.

It took 3 doctors to figure out finally that I had Raynaud’s, it took my dental hygienist to figure out why my throat was always red and swollen, an ENT and 2 others could not – I could go on……………

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[Anonymous]

What I would also suggest is that one be screened for sleep disorders since they can mimic ADHD symptoms. It doesn’t have to be a sleep study, just that the doctor does the due diligence of asking about one’s sleep. There are simple questionnaires available just like there are for ADHD. In some cases, the meds for a sleep disorder are the same as would be prescribed for ADHD, but there might be more going on than just ADHD and meds for that might just be masking a greater problem.

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[billd]

VERY well said, no_dop

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[Anonymous]

I just was diagnosed with ADD and was concerned about the choice of medication. My psychiatrist who specializes in ADHD (Boston, MA area) mentioned that if a person has any ‘serious’ like a heart arrhythmia or congenital problems then a cardiac risk assessment should be performed. She mentioned that many patients have been prescribed stimulants and are well tolerated and do not normally present a significant risk

In my case I am treated for hypertension and CAD. I was told that I should mention it to my GP that I have been prescribed Concerta 18mg (stimulant). My GP has my cardiac history and if he has any concerns please let my psychiatrist know before the dosage is increased.

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[billd]

Administrators – where’s that thumbs-up icon?

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[Anonymous]

Thanks for the input. Very helpful. Thank goodness my overall health is excellent. Strattera is being discussed right now.

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[billd]

I had side-effect with Strattera, but don’t with Adderall. Seems many folks are the opposite. In other words, “your mileage may vary”.

Good luck, I hope it helps……….

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[Anonymous]

laughing oh Billd my experience with Doctors is so like yours. I had 2 Toronto cardiologists examin me in ’92 for severe blackouts.

No stress test s suggested, and I didn’t know enough to ask … 7 years later a small town Internist saw me in Emerg, said you need

ablation .. sent to London Ontario, stress test, ablation treatment .. end to irregular heart beat … and fine until 2 years ago when a

hospital exam messed up on charts and thought I had a 4-5 cm aneurism in the upper aorta. After 4 weeks in cardio ward, an angiogram cleared up the error. As far as I know, I don’t have an existing heart condition .. except for high blood pressure and I’m on

pills for that. The combo of 300 Wellbutrin and 60 Straterra seemed to be doing a bit after two months, but now in the third month it

doesnt seem to be doing anything. Oddly, I feel more anxious and more stressed and of course more tired.

I am beginning to think that family doctors are useful only for basic, common medical issues …many of the ones I have seen had no

diagnostic skills worth the time i wasted waiting to see them for 5 minutes, while doctor read up on my file .. often not even remembering the recent highlights . At some point I will have to push for new drugs .. or something to slow down the anxiety.

As to the Straterra, at 60m side effects ran from dry mouth and stiffness in shoulders to slight urine retention … drinking more water

helped but various parts were tender .. that lasted for a couple of weeks. Seems to be lightening up, but the drugs seem to have less

of an effect now as well .. so not sure what that means.

One area of my ADHD that is a problem, is that I have severe problems with Transitions .. the startle response .. I really need some

stability .. drugs that may or may not work … not helping .. anyway good luck with your Straterra.

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[Gryffindork]

My shrink had me do an EKG, and decided my blood pressure is too high for stims. The BP is under control now, but I’m old & fat, so I don’t really want to try stims. My doctor agrees with me. I take welbutrin for depression, which has helped the add some. I think it could be better, but I don’t want to risk it.

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[Anonymous]

The overall risk of ADHD stimulants can be managed by a competent GP. If blood pressure is a problem you need to monitor and have you doctor manage any increases in blood pressure.

I was just put on Concerta and I have high blood pressure. Have a automated blood pressure monitor at home and if my BP increases I will let my GP know.

Also according to ADHD treatment guidelines stimulants are first line treatment. If you can’t tolerate stimulants then Strattera is used as second line therapy.

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[Wgreen]

This article appeared this morning (17 January, 2012):

http://news.yahoo.com/pediatricians-split-heart-tests-kids-adhd-meds-170205542.html

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[Anonymous]

Oddly, there is a heart and blood pressure warning on Strattera;

a warning that sounds not unlike the one for amphetamines .. but they are worse.

In addition, my pharmacist cautioned that as I increase the dose of Strattera and

Wellbutruin to their maximums, then I am likely increasing my risk.

In Canada, I find that I have to ask to have my blood pressure done, it isnt a

thing that is done regularly, and asking for cardio exam and stress test oddly

requires that I have symptoms and a history of cardio issues … happily, I am

60 and have all sorts of cardio history. There is of course, a long wait time to

see any specialist out here .. there are usually only 1 or 2 of any sort .. cheers.

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[Anonymous]

My psychiatrist merely asked me if I had any cardiac tests done after I told him I had been to the ER due to a panic attack. I’m not sure that he has the full results but it seems as though he just took my word for it. My test came back normal. I’d had an echocardiogram done as well as a 24 hour holter monitor after having palpitations after my panic attack. I still have random palpitations from time to time.

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[Author]

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