Disclosure(s): No relevant financial relationship(s) to disclose.
First Author: Prakrati Yadav, MD Co-Author: Amanda Carroll, n/a – Advanced Practice Provider, Critical care, Charleston Area Medical Center Co-Author: Vikhyath Terla, MD – Physician, Pulmonary and Critical Care, Charleston Area Medical Center
Introduction: Stimulants like Adderall and Ritalin are widely prescribed for attention-deficit/hyperactivity disorder (ADHD). While effective, they possess sympathomimetic properties that increase the risk of hypertension, tachyarrhythmias, and, in rare cases, cardiomyopathy- a serious and underrecognized complication.
Description: A 60-year-old female with a history of osteoarthritis, anxiety, restless leg syndrome, and ADHD on Adderall (30 mg daily since 2023) presented with sudden-onset dyspnea. She reported 6–8 weeks of chest pain, treated with NSAIDs and antibiotics. On admission, she was hemodynamically stable. EKG showed LBBB without ST elevations, and troponins were elevated with delta. Chest X-ray revealed pulmonary edema. Transthoracic echocardiogram showed EF < 10% with diffuse global hypokinesis, low-normal RV function, and mild mitral and tricuspid regurgitation. Left heart catheterization revealed 90% ostial LAD stenosis with otherwise non-obstructive coronary arteries. Given the extent of left ventricular dysfunction and diffuse hypokinesis not explained by a single-vessel lesion and absence of illicit substance use or other identifiable causes, her cardiomyopathy was attributed to chronic Adderall use.
Discussion: Though uncommon, stimulant-induced cardiomyopathy is increasingly recognized. A 2024 analysis of U.S. multicenter data found that young adults prescribed stimulants had a 17% increased risk of cardiomyopathy at one year and 57% at eight years compared to non-users. The absolute incidence of Adderall-induced cardiomyopathy was estimated at 0.72% over 10 years, compared to 0.53% in controls. Proposed mechanisms include catecholamine-mediated myocardial toxicity, sustained tachycardia, and increased afterload from hypertension. Risk is higher with prolonged use, high doses, misuse, or preexisting cardiac conditions. Multiple case reports document recovery of cardiac function after stimulant discontinuation. In this patient, severe global hypokinesis and reduced EF were disproportionate to an isolated LAD lesion and, in the absence of other causes, supported a diagnosis of Adderall-induced cardiomyopathy. Clinicians should maintain high suspicion in patients with unexplained LV dysfunction and a history of chronic stimulant use.
