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3 Normal cardiac energy metabolism and abnormal cardiac energy metabolism 3.1 Energy metabolism of the normal heart Under normal physiological conditions, the heart generates adenosine triphosphate (ATP) through mitochondrial oxidative phosphorylation, utilizing fatty acids oxidation (FAO), glucose, lactic acid, ketone bodies, and amino acids (AA) (34, 35)

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If symptoms persist beyond four to six weeks on a stable dose, discuss with your healthcare provider whether a dose reduction or slower titration schedule might help