JACC. Case reports · 2026
Shared Decision Making on Methylphenidate in Hypertrophic Cardiomyopathy and ADHD in a Young Athlete.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Rechcińska Aleksandra, Rechciński Tomasz
Аннотация
BACKGROUND: Exercise is not categorically contraindicated in hypertrophic cardiomyopathy (HCM), but concerns remain regarding sympathomimetic agents in patients with structural heart disease.
CASE SUMMARY: A 26-year-old man with HCM, diagnosed at age 16, was referred for assessment of methylphenidate safety for attention-deficit/hyperactivity disorder (ADHD) and social anxiety treated with paroxetine. Cardiac imaging over 10 years showed stable septal hypertrophy with preserved systolic function and no high-risk features. Electrocardiogram showed left ventricular hypertrophy and repolarization abnormalities; QT dispersion was 74 ms, below high-risk thresholds in HCM cohorts. After counseling on arrhythmic risk and possible electrocardiogram surveillance, the patient declined methylphenidate and chose psychotherapy-based ADHD management while continuing exercise.
DISCUSSION: This case shows how limited evidence on stimulant-related arrhythmic risk in low-risk HCM necessitates individualized assessment.
TAKE-HOME MESSAGES: Shared decision making can align ADHD treatment with arrhythmic risk in HCM. Even when stimulants appear acceptable, patients may choose nonpharmacological ADHD strategies.
CASE SUMMARY: A 26-year-old man with HCM, diagnosed at age 16, was referred for assessment of methylphenidate safety for attention-deficit/hyperactivity disorder (ADHD) and social anxiety treated with paroxetine. Cardiac imaging over 10 years showed stable septal hypertrophy with preserved systolic function and no high-risk features. Electrocardiogram showed left ventricular hypertrophy and repolarization abnormalities; QT dispersion was 74 ms, below high-risk thresholds in HCM cohorts. After counseling on arrhythmic risk and possible electrocardiogram surveillance, the patient declined methylphenidate and chose psychotherapy-based ADHD management while continuing exercise.
DISCUSSION: This case shows how limited evidence on stimulant-related arrhythmic risk in low-risk HCM necessitates individualized assessment.
TAKE-HOME MESSAGES: Shared decision making can align ADHD treatment with arrhythmic risk in HCM. Even when stimulants appear acceptable, patients may choose nonpharmacological ADHD strategies.