Fosphenytoin may cause hemodynamically unstable bradydysrhythmias

Exercise, Cardiac Rehabilitation, and Post–Acute Coronary Syndrome Depression

“…2 Similarly, fosphenytoin use has been described as resulting in hypotension, bradyarrhythmias and asystole. 3 To our knowledge, wide complex tachycardias have not been described. Two previous studies of phenytoin toxicity (with levels as high as 76 μg/mL) did not report any wide complex tachycardias or prolongation of the QRS or QT intervals.…”

“…At 8 years, this surplus persists (57 vs 41), though, as half the population had died, the true increased risk of DVT may not be fully captured. 3 Finally, population data repeatedly confirms the increased risk of DVT. 4 Third, Dr Hoffer 1 cites 2 studies supporting the IVC filter.…”

“…A high prevalence of adverse behavioral characteristics, including depression, has been observed in patients with coronary heart disease (CHD), particularly post-ACS, with marked benefits in these behaviors following ET-based cardiac rehabilitation (CR). 2,3 In fact, younger patients with CHD (age <55 years) had 50% to 80% reductions in the prevalence of depression, anxiety, and hostility following CR, and older patients had 30% to 70% improvements in the prevalence of these factors. …”

“…3 A recent single-site randomized clinical trial demonstrated that ET alone was associated with significant reductions in depressive symptoms and improved CHD biomarkers in patients with stable CHD and elevated depressive symptoms; reduced levels of depression were comparable to antidepressant medications, and both ET and medication use achieved greater reductions in depression compared with placebo. 4 In addition, results from the mul- coronary syndrome (ACS) randomized to centralized, stepped, patient-preference depression treatment (psychotherapy or medication use) had substantially fewer depressive symptoms after 6 months compared with those receiving enhanced usual care.…”

“…Indeed, Lavie and colleagues have been leaders in studying exercise as a treatment for depression, and they are to be commended for their rigorous work in this area. 2,3 Moreover, a recent Cochrane systematic review of randomized clinical trials in a variety of patient groups showed that exercise programs are superior to no treatment or to placebo control conditions for treating depression. 4 Nevertheless, we also agree with Lavie and colleagues that more randomized clinical trials of exercise as a treatment for depression after ACS are needed.…”