Analysis of patient-year exposure data for children on ADHD medications suggests that the rate of sudden death is similar to the general population but it is important for doctors to remain watchful. Patients with ADHD, like all pediatric patients, should undergo a careful history and physical examination that includes personal and family history details which may identify those at risk of sudden cardiac death. This should be performed by their primary care physician. Routine ECG assessment of ADHD patients prior to starting medication is not supported by evidence and is not recommended. For ADHD patients with known heart disease and followed by a cardiologist, the physician with expertise in ADHD likely remains the appropriate individual to evaluate benefit and risk and make recommendations for medication therapy, as there is little evidence that taking medication further increases the risk of sudden death. Discussion of treatment options with the cardiologist is appropriate with ultimate treatment decisions being made by consensus. "In-person" clinical review by the cardiologist specifically for ADHD risk assessment before starting treatment is generally unnecessary. For ADHD patients with suspected heart disease or identified risk factors for sudden death, assessment by a cardiologist is recommended. This would also be the case for a non-ADHD patient. A screening tool is provided with the guidelines to aid physicians in their clinical evaluation of children starting ADHD medication.

2009 Updated Guidelines for the Diagnosis and Management of Heart Failure ’ Chaired by Dr. Jonathan Howlett

The CCS commitment to delivery of timely and practical heart failure guidelines for health care providers continues. Due to results from needs assessments conducted nationwide, this year's heart failure update dealt with four important issues: the diagnosis and management of right-sided heart failure; diagnosis, investigation of myocarditis; updated intracardiac device therapy; and recommendations based upon recent landmark clinical trials.

What doctors need to know:

The diagnosis of right-sided heart failure requires increased level of suspicion and a slightly altered approach. Treatment varies according to the underlying condition. The diagnosis of myocarditis also requires increased level of clinical suspicion. The role of cardiac magnetic resonance imaging, consideration of early referral to an experienced centre, and updated role of RV biopsy is discussed. With new evidence from clinical trials assessing the use of intracardiac device therapy now available, the role of this therapy in patients' heart failure and narrow QRS complex, atrial fibrillation, and other conditions is addressed.

Recommendations arising from landmark clinical trials of heart failure and specific conditions such as atrial fibrillation, dyslipidemia, anemia, and decompensated heart failure are discussed.

Canadian Cardiovascular Society/Canadian Heart Rhythm Society Recommendations for the use of Genetic Testing in the Evaluation of Inherited Cardiac Arrhythmias Associated with Sudden Cardiac Death ’ Chaired by Dr. Michael Gollob

What doctors and allied professionals need to know:

Genetic testing for primary electrical and structural diseases of the heart associated with sudden cardiac death is now an expected component of patient/family care in many circumstances. Genetic testing may assist in the diagnosis of at-risk family members without clinically overt disease and impact on preventative medicine strategies. Genetic testing yields and interpretability of results differ between various genetic conditions, highlighting the need for expertise knowledge prior to ordering genetic tests. Decisions regarding the utility of genetic testing should be directed by clinical centres with specific expertise for these conditions, with assurance of pre-test genetic counselling by knowledgeable counsellors.

Source: Heart and Stroke Foundation of Canada