Acute myocardial infarction due to spontaneous coronary artery dissection in a 6-year-old boy with ADHD on the third day of treatment with methylphenidate

European Child & Adolescent Psychiatry (2021)Cite this article

Abstract

Methylphenidate (MPH) is an indirect-acting sympathomimetic drug and structurally related to amphetamine. It is widely used to treat children aged 6 years and older, as well as adolescents who have attention-deficit/hyperactivity disorder (ADHD). We report on a 6-year-old boy who presented with typical angina symptoms occurring several hours after intake of an increased dose of MPH, which had been initiated for ADHD treatment 2 days earlier. Despite typical angina symptoms, the diagnosis of myocardial infarction due to spontaneous coronary artery dissection of the right coronary artery was delayed. Most epidemiological studies could not detect an increased risk for cardiovascular events in association with ADHD medications. However, the direct temporal relationship in our case indicates the possibility that MPH may trigger spontaneous coronary artery dissection in predisposed patients. Since myocardial infarction in children is rare but comprises various etiologies, awareness of this possible catastrophic event among medical staff may be lower and may delay immediate life-saving diagnostic and therapeutic measures.

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Acknowledgements

The authors would like to thank Siobhan O’Leary for English editing assistance.

Funding

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Affiliations

  1. Drug Commission of the German Medical Association, Berlin, Germany

    Thomas Stammschulte, Martina Pitzer & Wolfgang Rascher

  2. Hospital for Child and Adolescent Psychiatry, Vitos Klinik Rheinhöhe, Eltville, Germany

    Martina Pitzer

  3. Clinic for Cardiology, Nephrology and Internal Intensive Care Medicine, Rhein-Maas Klinikum, Würselen, Germany

    Michael Becker

  4. Clinic for Pediatric and Adolescent Medicine, St. Marien Hospital, Düren, Germany

    Ulrich Pohlmann

  5. Department of Pediatric Cardiology, University Clinic Aachen, Aachen, Germany

    Stefan Ostermayer & Gunter Kerst

Authors
  1. Thomas Stammschulte
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  2. Martina Pitzer
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  3. Wolfgang Rascher
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  4. Michael Becker
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  5. Ulrich Pohlmann
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  6. Stefan Ostermayer
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  7. Gunter Kerst
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by TS and GK. The first draft of the manuscript was written by TS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Thomas Stammschulte.

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Stammschulte, T., Pitzer, M., Rascher, W. et al. Acute myocardial infarction due to spontaneous coronary artery dissection in a 6-year-old boy with ADHD on the third day of treatment with methylphenidate. Eur Child Adolesc Psychiatry (2021). https://doi.org/10.1007/s00787-021-01729-2

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Keywords

  • Methylphenidate
  • Myocardial infarction
  • Spontaneous coronary artery dissection
  • Attention deficit hyperactivity disorder
  • Adverse drug reaction