L carnitine is primarily synthesized in the liver from the amino acids lysine and methionine through a series of four enzymatic reactions, with the liver and kidneys converting the precursor butyrobetaine into active Carnitine metabolism in hypertensive heart failure Hypertension Research l Carnitine and heart disease ScienceDirect L Carnitine & Arterial Plaque Carnitine Deficiency: What Is It, Causes, Symptoms, and More Osmosis Role of L carnitine in Cardiovascular Health: Literature Review Cureus