New Guidelines Urge Heart Tests Before Taking ADHD Drugs

Excerpts from article by RON WINSLOW
Wall Street Journal
April 22, 2008; Page D1

Children diagnosed with attention deficit and hyperactivity disorder should have a thorough heart work-up, including an electrocardiogram, before taking stimulants such as Ritalin to treat the condition, according to a new recommendation by the American Heart Association.

The advice marks the first time a medical-guidelines body in the U.S. has urged wide use of an electrocardiogram, which charts electrical activity in the heart, to screen a presumed healthy population for abnormalities.

But there is debate among experts about the value of using the test to screen such a large pool of patients to detect a rare condition. The hope is that such a test -- in combination with a comprehensive checkup -- will help to avoid the rare cases of sudden cardiac arrest that have been linked to the widely used medicines.

AN ADHD CARDIAC CHECKLIST

A child diagnosed with ADHD should get a thorough heart checkup, including:

• Patient and family history, with special attention to palpitations, fainting or recent difficulties during exercise.

• A physical, including blood pressure and a check for abnormal heartbeats.

• An electrocardiogram to measure electrical function of the heart.

• If necessary, a consultation with a pediatric cardiologist to discuss important findings.

Source: American Heart Association

"The goal is to improve the care of children, including allowing them to have their ADHD treated and have it done safely," says Victoria Vetter, director of electrophysiology at Children's Hospital of Philadelphia and lead author of the heart association's statement.

More...

New Grants Available for Families Struggling With Child Health-Related Expenses

MINNEAPOLIS (April 10, 2008) – UnitedHealthcare Children’s Foundation (UHCCF) announced that new grants are available to help children who need critical health care treatment, services or equipment not covered or not fully covered by their parents’ health benefit plans.

UHCCF provides grants to families to help pay for child health care services such as speech therapy, physical therapy, occupational therapy sessions, prescriptions, and medical equipment such as wheelchairs, orthotics and eyeglasses.

Parents and legal guardians may apply for grants of up to $5,000 for child medical services and equipment by completing an online application at http://www.uhccf.org/. Tax-deductible donations can also be made online.

To be eligible for grants, children must be 16 years of age or younger. Families must meet economic guidelines, reside in the United States and be covered by a commercial health benefit plan. “We are taking action to improve access to health care in America and are dedicated to helping more children and families this year and beyond,” said Matt Peterson, UHCCF president. “We encourage families who need assistance paying for their child’s medical needs to visit the UnitedHealthcare Children’s Foundation Web site and apply today.”

The foundation aims to help more children by increasing awareness of the foundation through fund-raising events, partnerships, newspaper and Web advertising, and a revamped multimedia Web site, www.uhccf.org/.

About UnitedHealthcare Children’s Foundation
The UnitedHealthcare Children’s Foundation is a nonprofit 501(c)(3) organization that strives to enhance either the clinical condition or quality of life of children who have health care needs not fully covered by commercial health insurance. Foundation funding is provided by contributions from employees of UnitedHealth Group as well as individuals and corporations. While UHCCF receives contributions from UnitedHealth Group and its employees, individual and corporate donations to help provide assistance are deeply appreciated. To donate or learn more, please visit http://www.uhccf.org/.

CHD and Neurodevelopmental Risks

Risk of attention and behavior problems for kids with CHD
Children's Hospital of Philadelphia
Public Release, 7 April 2008

Schoolchildren who required surgery as infants for congenital heart disease (CHD) run a significant risk of having problems with inattention and hyperactivity, and often require remedial services in school. “These children are at risk for academic and behavior problems, and our findings reinforce how important it is to provide them with ongoing follow-up and neurodevelopmental screening,” said study leader Amanda J. Shillingford, M.D., a pediatric cardiologist at The Children’s Hospital of Philadelphia.

The researchers, who reported their findings in the April issue of Pediatrics, studied a group of 109 children, aged five to 10, who had undergone cardiac surgery for complex congenital heart disease at Children’s Hospital when they were newborns. Of that group, 53 children--nearly half of them--were receiving remedial services at school, and 15 percent were in special education classrooms.

Based on questionnaire responses from their parents and teachers, although the majority of the children with CHD scored in the normal range, the rates of high-risk scores for inattention and hyperactivity were three to four times greater than those found in the general population.

Previous studies at The Children’s Hospital of Philadelphia and other centers found that school-aged children with complex CHD tended to have normal cognitive abilities but were at risk for problems in visual and motor skills, as well as impairments in speech, language and executive functioning (executive functioning refers to capacities for attention, planning, decision-making and problem-solving).

“As survival rates have improved,” said Shillingford, “the important longer-term issue is quality of life for patients and their families as they reach school age and beyond. We hope our findings will help raise awareness among parents, teachers and physicians about the children’s risk of neurodevelopmental problems.” Shillingford added that a next step for researchers is to conduct larger, multicenter studies, with more formalized diagnostic tools, and to develop formalized follow-up protocols for these children. Such follow-up programs are currently being designed at Children’s Hospital.

New Techniques for Stenting in Adults with CHD

A pioneering paper was presented at last week’s Society of Interventioanl Radiology meeting, in Washington, DC by Dr John Moriarty, Specialist Registrar in Dublin’s Mater Hospital. The Mater is the only place in Ireland and one of a few places in Europe that places pulmonary valves in adult patients via stenting. This procedure, which is not yet licensed in the US, was examined with CT during Dr Moriarty’s presentation.

Moving beyond diagnosis and into therapy, interventional radiologists have new imaging techniques and new ways of getting into organs which, when combined, give an extremely powerful new tool that is changing the course of care for patients, in quality as well as quantity of life.

Posted in Research and Education on 29 March 2008

Transposition of the Great Arteries (TGA) and Genetics

The American Heart Association posted a new "Ask the Pediatric Cardiologist" question today on DTGA and genetic factors, including increased risk of having children in the future who also have heart defects. For information, click here. According to this source...

For a couple who's had one child with DTGA and has no other family members with transposition, the chance of having another child with DTGA increases slightly to about 18 in 1,000 or 1.8 percent. This is also about the same chance of this baby being born with a form of congenital heart disease other than DTGA. This gives a greater than 98 percent chance that the baby will be born with a normal heart.

Canadian Research News

For the complete article from LabCanada.com, please click here.

SickKids Foundation and the University of Toronto announced today a $2 million dollar donation from BMO Financial Group, which establishes the BMO Financial Group Chair in Cardiology. World-renowned SickKids clinician and researcher, and University of Toronto professor in paediatrics, Dr Andrew Redington has been named the inaugural chair holder.

The $2 million gift will allow Dr Redington to continue to pursue research and contribute to the understanding of congenital heart disease and heart function. Dr Redington's group is currently studying a novel technique developed at SickKids, that has already been shown to protect the heart and other organs from damage due to restricted blood flow during heart surgery.

"Through BMO's generosity and Dr Redington's vision, today's announcement effectively solidifies SickKids as a world leader in children's cardiac medicine," said Mary Jo Haddad, president and CEO at SickKids. "An endowed chair for our head of cardiology is a powerful tool in both retaining people like Dr Redington while recruiting others with similar credentials in the years to come."

Under The Labatt Family Heart Centre headed by Dr Redington, SickKids currently performs 80% of all children's heart transplants in Canada and cares for 80% of all the children in Ontario with congenital heart defects. More than 60% of children requiring heart surgery are under one year of age, and almost a quarter of children requiring surgery are in their first month of life.

Making a Difference

It seems that the majority of people out there working on congenital heart defect awareness, advocacy and research funding are parents whose lives have been forever changed by their child's diagnosis heart defect.

I recently read an article about one such person named Linette Derminer who has worked hard to get AED devices into schools after her son passed away from an undiagnosed CHD at the age of 17. She even created a foundation called the Parent Heart Watch, to promote research, advocacy, equipment donations and awareness of Sudden Cardiac Arrest (SCA) in youth, which is often attributed to an undiagnosed CHD. She has been nominated for Cleveland Woman of the Year. If she wins, she gets a shopping spree, but more importantly, her charity will receive a hefty sum from Chevrolet. Please join me in supporting her efforts by casting your vote for her today at http://www.clevelandwoy.com/finalists.asp.

The ParentHeartWatch gives the following astonishing statistics:

• National Center for Catastrophic Sports Injury reports 5-15 cases annually. This is sponsored by the NCAA and NFHS. It only records High School and College and only in the sanctioned sporting event.
  
• The Sudden Death Athletes registry records about 300 cases annually. It records athletes between the age of 15-35.
  
• The Center for Disease Control reported 2504 cases of heart disease deaths in their latest report year of 2002 under age 24. Over half were in the 15-24 age group. This does not include cases of impact to the chest or secondary effect from other causes such as lightning, heatstroke, etc.
  
• SCA is estimated to affect up to 7,000 young people annually according to the Pediatric Clinics of North America Journal #1999; 46(2):221-234
  
• An estimated 14,000 children and infants die annually from SCD according to the Heart Rhythm Society in May 2004

Great work, Ms. Derminer! You are just one awesome example of the many people out there making a difference for both today's and tomorrow's children by refusing to forget the struggles of yesterday's and today's CHD patients.

"A hero is not an extraordinary person but an ordinary person that does extraordinary thing"
-Christopher Reeves