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Fetal hearts use glucose as their primary metabolic substrate. Adult hearts use free fatty acids, which are less efficient (require more $O_2$ to synthesize the same amount of ATP); however, during cardiac failure, the heart can switch to glucose utilization. Why doesn't it just use glucose all the time?

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  • $\begingroup$ The heart uses lipid and glucose (although the fatty acids contribute a much greater fraction to cardiac energy production - you can experimentally cause damage to the cardiac myocytes if you decrease the ability of the heart to metabolize either glucose or fatty acid fuels $\endgroup$ – Vance L Albaugh Dec 3 '15 at 7:14
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Lipids require more oxygen to burn, but also they are cheaper to store (since they have great calorific power than carbohydrates and they're hydrophobic, thus not requiring water for their storage). The body can store so much lipids that it becomes an almost everlasting energy source (A normal adult have enough energy stored as fat to allow basal metabolism for weeks to months), which cannot apply to glucose. If fat is not present, glucose would have vanished from the body long time ago. Glucose levels must be maintained at a certain level, because it's the main energy source for the brain (which cannot use lipids ). The brain can use ketone bodies (product of fat oxidation) as a last resort.

For all the previous reasons, the heart (and many other organs, like the liver) uses fat while possible. If possible just means when not starving to death and with sufficient oxygen supply. This second condition doesn't apply to heart failure. In this case, oxygen supply fails and the tissue switch to glucose just because they can use it without oxygen (glycolysis and lactic fermentation).

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The usual explanation is that glucose is potentially dangerous because there is always a chance glycolysis will run too fast and produce lactic acid. While lactic acid buildup is no big deal for a skeletal muscle, lactic acid build up in the heart can affect the ion channels and hence the heart rhythm.

Fuels for the heart are fatty acids, ketone bodies, and lactic acid taken from the blood. Evidently when the source of lactic acid is the blood, the heart does not take it up any faster than it can convert it to pyruvate (and then to AcCoA, etc.)

Since aerobic metabolism is so important for the heart, is has a high content of mitochondria.

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  • $\begingroup$ Welcome. Could you add sources to your answer? As a scientific stack we appreciate, and factually demand answers to be backed up by references. $\endgroup$ – AliceD Aug 23 '17 at 23:33
  • $\begingroup$ Why will glycolysis run too fast? Any reason? $\endgroup$ – Anubhav Goel Aug 24 '17 at 2:55

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