Cardiovascular and respiratory system
Study
Cardiovascular events
Munk 2015	The present case demonstrates that myocardial infarction can occur due to methylphenidate exposure in a healthy 11‐year‐old boy, without other known cardiovascular risk factors. 54 mg methylphenidate/day. Treatment duration was 2 years. Cardiac arrest followed exercise without prior complaints of chest pain/discomfort or shortness of breath. A week before the event, he had a short episode of tachycardia. Clinical examination showed that the myocardial infarct was not acute but had occurred weeks prior to the cardiac arrest. It was thought to be due to thinning of the myocardium and an adversely remodelled left ventricle. A pacemaker was inserted and methylphenidate treatment was discontinued. The only apparent cause, after extensive assessment, appeared to be the high‐dose methylphenidate treatment (maximum recommended) over an extended period
Nymark 2008	A case report of serious cardiomyopathy during MPH treatment. Serious cardiovascular adverse effects (hypoxia and dyspnoea requiring hospitalisation) after 11 months of MPH treatment. Clinical examination showed signs of liver failure, renal failure and heart failure Comments of the study authors (Nymark et al): With a BMI of 40 our patient had extreme obesity. The hyperdynamic circulation, with increased cardiac output, was thought to be a compensatory adaptation to increased adipose tissue. This may have led to non‐ischaemic dilated cardiomyopathy at the expense of left ventricular hypertrophy and remodeling as may occur in severely obese subjects (McGavock et al 2006). This is, however, unlikely as the only cause in our young patient. Human obesity is also characterized by sympathetic nervous system activation (Eikelis and Esler 2005). A possible obesity‐linked susceptibility to the toxic effect of methylphenidate could therefore play a role in the development of DCM in our patient, especially with regards to the short treatment time of one year
Hypertension
Saieh 2004	A case report of hospitalisation due to hypertension during MPH treatment Serious adverse events 72‐hour hospitalisation, emergency unit Abdominal pain for four days prior to hospitalisation, intermittent accentuation (hours), no other symptoms Secondary hypertension: Persistent hypertension (158/88‐170/105, pulse: 78‐98 bpm). Normal physical examination. Normal eye fundus and normal cardiological examination Discontinuation of MPH: Hypertensive treatment only necessary for 24 hours Normal blood pressure after one week