Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobiological disorder exhibited by difficulty maintaining attention, as well as hyperactivity and impulsive behavior. Central nervous system (CNS) stimulants are the first line of treatment for ADHD. With the increase in number of adults on CNS stimulants, the question that arises is how well do we understand the long-term cardiovascular effects of these drugs. There has been increasing concern that adults with ADHD are at greater risk for developing adverse cardiovascular events such as sudden death, myocardial infarction, and stroke as compared to pediatric population. Cardiovascular response attributed to ADHD medication has mainly been observed in heart rate and blood pressure elevations, while less is known about the etiology of rare cardiovascular events like acute myocardial infarction (AMI), arrhythmia, and cardiomyopathy and its long-term sequelae. We present a unique case of AMI in an adult taking Adderall (mixed amphetamine salts) and briefly discuss the literature relevant to the cardiovascular safety of CNS stimulants for adult ADHD.
Highlights
Adult Attention-deficit/hyperactivity disorder (ADHD) affects an estimated 3% to 5% of adults worldwide
Central nervous system (CNS) stimulants act by inhibiting reuptake of norepinephrine and dopamine as well as increasing their release into the extracellular space
A 31-year-old Caucasian man presented to the emergency room with palpitations associated with shortness of breath and lightheadedness. He was diagnosed with ADHD at 15 years of age and was prescribed mixed amphetamine salts
Summary
Adult ADHD affects an estimated 3% to 5% of adults worldwide. It is seen in 4.4% (62% male, 38% female) of the US adult population [1]. ADHD patients have cooccurring psychiatric disorders, like anxiety (47%), mood disorder (38%), poor impulse control (20%), and substance use disorders (15%) [1] These individuals can be on a number of medications along with stimulant drugs; effect of combination drug therapy on cardiovascular system has not been well studied. A 31-year-old Caucasian man presented to the emergency room with palpitations associated with shortness of breath and lightheadedness He was diagnosed with ADHD at 15 years of age and was prescribed mixed amphetamine salts. After about 1-2 hours, he developed significant palpitations that were different in nature and lasted longer along with shortness of breath and lightheadedness without any chest pain, nausea, or diaphoresis His past medical history was unremarkable except for ADHD. Patient had uneventful hospital course and was discharged on third day
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