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Chronic obstructive pulmonary disease (COPD) induces dynamic hyperinflation, increases intrathoracic pressure (ITP) and PVR, compresses the LV and reduces stroke volume via direct ventricular interaction (DVI), a mechanical constraint worsened by the loss of elastic recoil in emphysema

Those at a higher risk for developing a deficiency in Vitamin B12 levels include older adults, people with pernicious anemia, people with low stomach acid, people with malabsorption problems due to digestive problems such as IBS, gastritis, Colitis and Crohns (Ref) and certain medications