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Individuals with risk factors for B12 deficiency including strict vegans, those with gastrointestinal conditions, patients taking long-term metformin or proton pump inhibitors, and older adultsshould discuss screening with their GP, even in the absence of obvious symptoms

Other causes include stenotic lesions (aortic and pulmonary stenosis, coarctation of the aorta, tetralogy of Fallot) or relative pulmonary stenosis due to increased flow from an ASD Crescendo decrescendo murmur b) Holosystolic (regurgitant) murmurs start at the beginning of S1 (pulse) and continue to S2

It requires careful dosing due to potential severe cardiotoxicity if accidentally injected into a blood vessel, may cause symptoms such as dizziness, confusion, seizures, or cardiac arrest

Limit alcohol, avoid doubling a missed dose, and do not drive if dizziness or weakness occurs