Shared Decision Making on Methylphenidate in Hypertrophic Cardiomyopathy and ADHD in a Young Athlete

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Hypertrophic cardiomyopathy and ADHD (n=1). Intervention: Methylphenidate.

Q: What does this research mean for the field?

Shared decision making regarding methylphenidate use in hypertrophic cardiomyopathy allows individualized alignment of arrhythmic risk with treatment preferences, leading some patients to select nonpharmacological ADHD strategies. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Aleksandra Rechcińska; Tomasz Rechciński

doi:10.1016/j.jaccas.2026.108797

July 1, 2026JACC Case ReportsOpen Access

Shared Decision Making on Methylphenidate in Hypertrophic Cardiomyopathy and ADHD in a Young Athlete

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Key result

Shared decision-making in low-risk HCM with ADHD leads patient to choose psychotherapy over methylphenidate.

n=1

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Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Concerns remain regarding sympathomimetic agents in patients with structural heart disease, and evidence on stimulant-related arrhythmic risk in low-risk HCM is limited.

Key Points

To evaluate the safety and clinical decision-making process regarding methylphenidate initiation for ADHD in a 26-year-old athlete with hypertrophic cardiomyopathy.
Conducted cardiovascular risk stratification in a 26-year-old male athlete with hypertrophic cardiomyopathy using 10-year serial imaging, 12-lead electrocardiography, and the 5-year sudden cardiac death risk model.
Assessed spatial QT dispersion across 12 leads on resting electrocardiography to evaluate myocardial repolarization heterogeneity.
Implemented a multidisciplinary shared decision-making model comparing methylphenidate initiation under biweekly electrocardiographic surveillance with nonpharmacological ADHD management.
Resting 12-lead electrocardiogram demonstrated left ventricular hypertrophy and repolarization abnormalities with a spatial QT dispersion of 74 ms (mean: 408 ms; QT range: 344-418 ms; SD: 20.5 ms), remaining below the high-risk threshold of 93 ms.
Cardiovascular evaluation identified a 5-year estimated sudden cardiac death risk of 2.75%, preserved left ventricular ejection fraction above 50%, and a resting outflow tract gradient of 28 mm Hg.
Following clinical counseling on arrhythmic risk and monitoring requirements, the patient declined methylphenidate and chose psychotherapy-based ADHD management while maintaining regular exercise.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 26-year-old man with low-risk hypertrophic cardiomyopathy and newly diagnosed ADHD evaluated for the safety of methylphenidate initiation.

I

Intervention

Assessment for methylphenidate initiation with structured ECG surveillance

O

Outcome

Patient decision on ADHD management strategy

Shared decision making in patients with low-risk hypertrophic cardiomyopathy and ADHD can help align psychiatric treatment needs with arrhythmic risk, even leading to nonpharmacological choices.

Limitations

Limited evidence on stimulant-related arrhythmic risk in low-risk HCM
Prognostic value of QT dispersion remains uncertain

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Implication

Shared decision-making may guide ADHD management choices in low-risk HCM; this case leaves open methylphenidate safety.

Abstract

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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Cite This Study

Rechcińska et al. (2026) conducted a case report in Hypertrophic cardiomyopathy and ADHD (n=1). Methylphenidate was evaluated. A 26-year-old man with low-risk hypertrophic cardiomyopathy and ADHD opted for psychotherapy over methylphenidate after shared decision-making regarding potential arrhythmic risks.

synapsesocial.com/papers/6a5b38f68167787360d24dd6 https://doi.org/10.1016/j.jaccas.2026.108797

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Shared Decision Making on Methylphenidate in Hypertrophic Cardiomyopathy and ADHD in a Young Athlete

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Shared Decision Making on Methylphenidate in Hypertrophic Cardiomyopathy and ADHD in a Young Athlete

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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