New thoughts of pathophysiology and therapy of ischemic heart disease.

L-carnitine has an important role in the metabolism of fatty acids. These molecules are carried to the mitochondrion after binding with L-carnitine. Fatty acids are oxidated in the mitochondrion only after binding with L-carnitine. Clinical experience suggests that this drug may have an important role in the treatment of several cardiovascular disorders. Experimental studies also suggest that there is a rationale for the clinical use of L-carnitine in the treatment of ischemic heart disease. This drug has been tested in patients with acute myocardial infarction, myocardial ischemia (with beneficial effects on symptoms and stress tolerance) and peripheral vascular disease. Preliminary results in patients with cardiac failure suggest that this drug may reduce cardiac arrhythmias and may allow the reduction of digoxin therapy.