Should a 25-year-old male patient on Vyvanse (lisdexamfetamine) for Attention Deficit Hyperactivity Disorder (ADHD) with intermittent palpitations and Left Atrial Enlargement (LAE) criteria on leads V1-V2 undergo an echocardiogram?

From the Guidelines

A 25-year-old male patient on Vyvanse for ADHD with intermittent palpitations and Left Atrial Enlargement (LAE) criteria on leads V1-V2 should undergo an echocardiogram to assess for underlying structural heart disease. This recommendation is based on the potential for Vyvanse to exacerbate underlying cardiac conditions, and the presence of palpitations and ECG findings suggestive of LAE, which may indicate a need for further cardiac evaluation 1.

Key Considerations

• The patient's symptoms of intermittent palpitations and ECG findings of LAE in leads V1-V2 warrant further investigation to rule out underlying structural heart disease.
• Vyvanse, a stimulant medication, can increase heart rate and blood pressure, potentially exacerbating underlying cardiac conditions.
• An echocardiogram is a non-invasive cardiac imaging test that can provide important information about left atrial size, ventricular function, valve structure and function, and other cardiac parameters.

Clinical Implications

• If structural heart disease is identified, medication adjustments may be necessary, such as dose reduction or switching to a non-stimulant ADHD medication.
• Even if the echocardiogram is normal, the information would be valuable for establishing a baseline and providing reassurance.
• The combination of stimulant medication, palpitation symptoms, and ECG abnormalities creates sufficient clinical concern to justify further cardiac evaluation with echocardiography, as supported by guidelines for the clinical application of echocardiography 1.

From the FDA Drug Label

Your healthcare provider should check you or your child carefully for heart problems before starting treatment with lisdexamfetamine dimesylate capsules. Tell your healthcare provider if you or your child have any heart problems, heart disease, or heart defects Call your healthcare provider right away or go to the nearest hospital emergency room right away if you or your child have any signs of heart problems such as chest pain, shortness of breath, or fainting during treatment with lisdexamfetamine dimesylate capsules.

The patient has intermittent palpitations and Left Atrial Enlargement (LAE) criteria, which are signs of potential heart problems. Given this information, it is reasonable to consider an echocardiogram as part of a thorough evaluation of the patient's heart health, especially since the patient is already on lisdexamfetamine for ADHD. Key considerations for this patient include:

• The presence of heart problems or heart disease may require careful monitoring and evaluation
• The patient's symptoms of intermittent palpitations and LAE criteria on leads V1-V2 may indicate a need for further cardiac evaluation
• The healthcare provider should carefully weigh the benefits and risks of continuing lisdexamfetamine treatment in this patient 2

From the Research

Diagnostic Considerations

• The patient's symptoms of intermittent palpitations and Left Atrial Enlargement (LAE) criteria on leads V1-V2 warrant further investigation, particularly in the context of their Vyvanse (lisdexamfetamine) treatment for Attention Deficit Hyperactivity Disorder (ADHD) 3.
• Electrocardiography (ECG) can be a useful initial diagnostic tool for assessing left atrial enlargement, with various studies demonstrating its utility in this context 4, 5, 6, 7.
• However, the diagnostic accuracy of ECG for left atrial enlargement can be limited, with sensitivity and specificity values ranging from 54.4% to 72% and 57.1% to 100%, respectively 4, 5, 6, 7.

Echocardiogram Considerations

• Echocardiography is considered the gold standard for measuring left atrial size and assessing left atrial enlargement 4, 6, 7.
• Given the patient's symptoms and ECG findings, an echocardiogram may be necessary to confirm the presence and extent of left atrial enlargement, as well as to rule out other potential cardiac abnormalities 3.
• The combination of ECG and echocardiography can provide a more comprehensive understanding of the patient's cardiac status and guide further management decisions 4, 5, 6, 7.