Should I really keep taking this medication?
October 7, 2014 1:54 PM   Subscribe

I had an abnormal ECG but my doctor advised me to keep taking stimulant medication.

I was recently diagnosed with inattentive type ADD, and prescribed 18mg of Concerta. The drug has been working really well and I felt really happy to have found it.

My doctor ordered an EKG and reviewed the results with me today.

My heart rate was 57 bpm, and the print out said "atrial bradycardia". In response to this my Dr. is ordering a 24-hour holster test, which will take a couple months to get. She advised me to keep taking the medication in the meantime.

The print out also said "Borderline ECG", which my Dr. attributed to the bradycardia. But when I looked up the numbers, I also noticed that my PR interval is abnormal (101). I don't know what this means, but I am slightly concerned that the Dr. didn't address it. Especially because "Borderline ECG" was written next to the PR interval number. Also from my fumbling internet searches it seems like a short PR interval usually occurs in tandem with tachycardia, but mine is with bradycardia…so maybe that's significant?

Can anyone point me in the direction of further resources to try to figure out if it is safe for me to continue taking the meds? I really don't want to lose two more months of productivity by not taking them until I get the holster test. I'm in a really busy semester and was really happy that I was finally able to focus on my work!

Thanks :)
posted by whalebreath to Health & Fitness (10 answers total) 1 user marked this as a favorite
I would not use the internet to second-guess the specific instructions that your doctor gave you based on the test results that they evaluated. If you're concerned, ask your doctor for more details about why they gave you the advice that they did.
posted by quince at 2:12 PM on October 7, 2014 [4 favorites]

IANAD, and IANYD, but I can point out at this juncture that stimulants like Concerta do not typically have bradycardia as a side effect; if anything, they would be more likely to cause the exact opposite: tachycardia.

Follow your doctor's instructions; she knows what she's doing.
posted by fifthrider at 2:15 PM on October 7, 2014 [4 favorites]

Can anyone point me in the direction of further resources

I would call your doctor's office and ask more questions, and if you continue to be concerned, to ask for a referral for a second opinion.
posted by rtha at 2:15 PM on October 7, 2014 [3 favorites]

If you are unsure ask your pharmacist. If you're doctor said it was okay it probably is okay. If another doctor prescribed the medicine is ask that doctor as well.
posted by AlexiaSky at 2:16 PM on October 7, 2014 [1 favorite]

Best answer: "Can anyone point me in the direction of further resources..." I have found it very helpful to talk to reference librarians at my local medical school library. It's a bit surprising, but many med school libraries will allow the general public to do research there, although you can't check out materials. Also, PubMed (also known as Medline) is enormously useful, though perhaps not the most user-friendly system in the world.

For what it's worth, I'm all in favor of second-guessing the specific instructions given by doctors (or by other authority figures, for that matter). I correctly diagnosed myself with hyperparathyroidism by doing Internet searches -- a diagnosis that was missed earlier by several doctors (who really ought to have known better).
posted by alex1965 at 2:40 PM on October 7, 2014 [1 favorite]

Best answer: EKG is an old (but good) technology where measurements of the electrical activity of your heart are used to make assessments about its function. While EKGs take valid measurements for these assessments the computer-based interpretations on these machines are notoriously inaccurate. They tend to vastly over-represent any abnormalities and often mistake interference, even just from slight movements of the patient, for abnormalities.

In short - don't pay attention to the words automatically printed on the EKG. Humans are much better at reading EKGs than machines. Listen to your doctor.

Also, in case you're having trouble with search terms, the test is called a "Holter monitor."
posted by arrmatie at 3:15 PM on October 7, 2014 [3 favorites]

Do you trust your doctor? (By that, I mean, has she given you any reason in the past to doubt her? If so, how often?) If you trust her, I would follow her instructions and not try to self-diagnose via the internet. Reading up on medications, side effects, and conditions on the internet is all well and good, and can help you have an intelligent conversation with your doctor -- but it cannot replace her training and experience.

If you're truly concerned, and your insurance isn't an HMO, make an appointment with another doctor (in a different office) for a second opinion -- tell him or her the EKG results and your concerns from your internet research. The second doctor will either agree or disagree with your doctor.
posted by tckma at 4:44 PM on October 7, 2014

I am not a medical doctor.

I don't know where you're located, but is the situation that you can't be referred to a cardiologist to get the Holter monitor for two months? What's medical plan do you have that requires a two-month wait for a referral? Is there any way you can get a referral (if you need one) to a cardiologist sooner?

I agree that you should call the doctor and express your concerns.

I would not do internet research on this without having a background in medicine. However, my default position would be that, if I couldn't get into see another doctor, to continue the medication, because, you're right, a slow heart rate is not what stimulants do.
posted by DMelanogaster at 5:17 PM on October 7, 2014

I totally secondguess my psychiatrist. I wouldn't have found the stuff that's been helping my skin-picking so much if I hadn't done that. But this is something where I think people hear "heart" and assume that any variation from normal is reason to panic. If your doctor says it's okay AND you feel fine or in fact improved over when you weren't taking it, I don't think it's worthy of doing extensive and worrisome internet reading over. As internet research goes, though, Wikipedia says that bradycardia is under 60bpm--which means you're only barely there--and it's generally not a problem until it gets under 50, that it's fairly normal for it to be low and asymptomatic, and if it's asymptomatic it's not worth worrying about. This is the same Wikipedia which is usually not at all shy about encouraging my hypochondriac tendencies.

I've had some weird problems since I started on Adderall--heart palpitations and elevated blood pressure sometimes, blood pressure tending to tank when I get dehydrated which now happens constantly--but as long as I watch my fluid/salt intake I've been feeling pretty okay, and this has been an extended period. 18mg of Concerta is not very much at all. I think if your body says you're feeling fine, and your doctor says you're fine, and Wikipedia which usually says you might have some rare hereditary disease previously known only in one small family of Norwegians says you're probably fine, it's safe to assume that you're fine.
posted by Sequence at 8:37 PM on October 7, 2014

I can't tell you if you should keep taking the medication, no one here can - but I can give you a little general information on EKGs, and reinforce the message that the best person to determine if you should keep taking your medication is your doctor.

The printout on the EKG is often incorrect in its interpretation (because it's interpreted by a computer and not a human) so I have no idea what your EKG really showed, but 57 is not a really abnormal heart rate for many people - some people just run on the low side and particularly athletes tend to be more on the bradycardic side and that is normal for them.

You seem to be completely depending on the EKG machine reading for your concerns - you should talk to your doctor instead. For example, even though the machine said you had an atrial bradycardia, it might have actually been a sinus rhythm (conducted normally through the heart instead of abnormal conduction). In fact the whole reading of 'atrial bradycardia' is a little odd, that's an unusual term that is rarely discussed in medicine. "Borderline EKG" could mean a lot of things - and it probably doesn't mean anything. The fact that the words were next to the PR interval is just how the EKG printout is formatted, it doesn't mean that phrase refers to the PR interval necessarily - here's another EKG with the same reading on it to compare (that's a normal PR interval).

I would definitely recommend talking to a doctor about this if you're still concerned - you could try a pharmacist, but pharmacists don't read EKGs, so they are unlikely to really be able to enlighten you. Psychiatrists also don't generally read EKGs, and so if your prescribing doctor is a psychiatrist, I would recommend talking to your primary care doctor who has more EKG reading knowledge.

I very much hope you won't make the decision about what to do based on some random internet research and googling, but if you want to read a somewhat relevant link, here's one that might be somewhat accessible.
posted by treehorn+bunny at 3:46 AM on October 8, 2014

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