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When oxygen availability is limited, glucose is the most metabolically efficient fuel, and during myocardial ischemia, the ratio of acetyl-CoA/CoA in mitochondria increases, leading to the activation of pyruvate dehydrogenase (PDH) kinase, which in turn phosphorylates PDH to inhibit its activity

Acetyl L-carnitine is extensively distributed in tissues, with higher concentrations in the cardiac muscle and in the skeletal system

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