In children with unknown family cardiac history, do you require a routine EKG prior to starting a stimulant?

The American Academy of Pediatrics (AAP) and the American Heart Association (AHA) have stated that ADHD medications have not been shown to cause heart conditions or sudden cardiac death, although stimulant medications do increase heart rate and blood pressure. By increasing sympathetic nervous syste...

In practice, I generally do not get an EKG unless there is a reason to. Reasons can be personal history of fainting/dizziness, chest pain with exercise, palpitations, etc., even with an unobtainable family history. I also like to get an EKG during titration only if such symptoms develop during treat...

I think it's always helpful to have a baseline EKG in such instances.

Practice recommendations (AAP, AHA) recommend pre-stimulant EKG or cardiac referral based on personal/family history of cardiac risk/symptoms, baseline cardiac exam, and baseline BP/pulse. If family history is unknown, this does not by default indicate a need for EKG, however it may lower my thresho...