Shared Decision Making on Methylphenidate in Hypertrophic Cardiomyopathy and ADHD in a Young Athlete
Aleksandra Rechcińska1, Tomasz Rechciński2
1Central Teaching Hospital of the Medical University of Lodz, Lodz, Poland.
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.
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