ADHD Cardiovascular Assessment — MRCPsych Paper B MCQ
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Correct answer: B — Baseline pulse and blood pressure, with a cardiovascular history and examination
The correct answer is B. NICE requires a physical-health review before starting ADHD medication, including baseline pulse and blood pressure measured with an appropriately sized cuff and compared with age-appropriate ranges, together with a cardiovascular assessment incorporating relevant personal and family history and examination. A routine ECG, echocardiogram or Holter monitor is not required when the cardiovascular history and examination are normal and there is no other increased cardiac risk. Cardiology referral is reserved for specified findings, such as congenital heart disease, exertional syncope, cardiac-type chest pain, sudden death in a first-degree relative under 40 years suggesting cardiac disease, heart failure signs or a cardiac murmur. Children with blood pressure consistently above the 95th centile require referral to a paediatric hypertension specialist.
Reference: National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations 1.7.4–1.7.6. 2018; recommendation 1.7.4 amended 2019. https://www.nice.org.uk/guidance/ng87/chapter/recommendations