What's a little chest pain when I can at least pay attention to the ER doc when he tells me I've had my first heart attack!

This one made me a bit worried . . . 

I am a 30 year old male, and I’ve been taking stimulant ADD meds for about 15 years. The last 5 years I’ve been on Metadate CD 60mg every AM. Worked pretty good, and insurance covered most of it.My doctor switched me to Focalin XR,20mg AM. The Focalin seemed less potent, but I liked the idea of taking only 20 mg. Then, 3 days ago she switched me to Vyvanse, 50mg. Once daily. Wow. BIG difference. I actually, for the first time in my life feel like my ADD has been cured. The Metadate and Focalin made my armpits sweat uncontrollably. I was always nervous, jumpy and twitchy. Until 3pm, when it wore off. Then I felt like a zombie. I NEVER took it when I wasn’t at work, because I hated the way it made me feel. The Vyvanse is so different, comes on so subtle you hardly notice, then once you realize “hey, the meds are kicking in” it’s like 8 hours of pure concentration, no sweaty armpits, no jitters,just a brain that feels organized and efficient. Then the “comedown” is the same. You don’t even notice it until later, it’s sort of an incidental thing as opposed to a day-ruining crash. It is a lot more gentle than Methylphenidate. No huge speedy rush, no big irritable crash. One thing that makes me a little leery. I have noticed a slight chest discomfort at times. Just an ache near my breastbone that lasts maybe 5 min., then goes away completely. This has happened at least once every day I’ve taken Vyvanse. Usually twice. The reason I’m leery is I have a wife and 2 little kids. I have never been on anything other than Methylphenidate, now I’m on a form of Amphetimine which I KNOW is less safe. I hope that 15 years of ADD meds haven’t screwed up my heart. I would rather live with ADD than die young. It really bums me out, because finally I found something that works, and naturally it’s probably less safe.

Thanks for the ringing endorsement of Vyvanse . . . we all found it very helpful . . . Now how ’bout you CALL YOUR DOCTOR!!!!  While I am almost positive about your chest pain be inconsequential and of no concern, you CANNOT assume that this is true.  You must stop taking the Vyvanse and contact your doctor immediately.  I strongly urge that you push for . . . nay . . DEMAND . . . a thorough cardiac work-up to assess the nature of the nature of the pain you are experiencing.  While it is most likely nothing more than chest wall muscle spasm or some such musculoskeletal issue, being wrong risks catastrophe.  

As you probably know, there has been recent concern about the association between use of stimulants and cardiovascular events such as arrhythmias, heart attacks, and strokes. While the risk seems to be highest in patients with structural heart abnormalities, researchers have not ruled out completely the possibility of increased risk in patients without structural heart abnormalities.  Recently, the American Heart Association made a recommendation that all patients who receive stimulant medication get a screening EKG.  This is, at best, a crude tool to evaluate for a structural heart issue, but it is easy and relatively cheap.  

But your situation is way beyond that.

ANY PATIENT who experiences ANY chest discomfort while taking stimulants MUST stop taking the stimulant and receive a thorough cardiac work-up.  PERIOD.  While this should be an EKG at least, if you were my patient, I would want an echocardiogram and an exercise stress test to rule out the presence of coronary artery disease.  Talk to the cardiologist, but my preference would be to have the test done while you were on the Vyvanse.  That way we get an idea of what is happening to your coronary arteries while you are on the medicine.  It is possible that you could be experiencing some spasm of your coronary arteries that produces transient decreases in blood flow to your heart.  That could set the stage for a heart attack.  We don’t want that.  If that test is clear, I would assume that you would get the green light for continued use of the medicine.  But that is not for you or me to determine.

Now, the other part of your question involved “screwing up” your heart with 15 years of ADD medicine.  The issue with stimulant use is not related to long term use.  There is no reliable evidence that long term use of stimulant medication is associated with any specific cardiac injury.  Patients have been on these medications for decades at a time.  The worry with the stimulants is more the “here-and-now” effects like chest pain (aahheeemmmm!!) , heart attack and stroke.

Stop playing with fire and putting your family at risk of catastrophe.  

Call your doctor.

NOW!

–Dan Hartman, MD