Cardiac myocytes Ca2+ and Na+ regulation in normal and failing hearts.

Ca(2+) is a central player in the excitation-contraction coupling of cardiac myocytes, the process that enables the heart to contract and relax. Mishandling of Ca(2+) is a central cause of both contractile dysfunction and arrhythmias in pathophysiological conditions such as heart failure (HF). Upon electrical excitation, Ca(2+) enters the myocytes via voltage-gated Ca(2+) channels and induces further Ca(2+) release from the sarcoplasmic reticulum (SR). This raises the free intracellular Ca(2+) concentration (Ca(2+)), activating contraction. Relaxation is driven by Ca(2+) decline, mainly due to re-uptake into the SR via SR Ca(2+)-ATPase and extrusion via the sarcolemmal Na(+)/Ca(2+) exchange, NCX. Intracellular Na(+) concentration (Na(+)) is a main regulator of NCX, and thus Na(+) plays an important role in controlling the cytosolic and SR [Ca(2+)]. Na(+) may have an even more important role in HF because NCX is generally upregulated. There are several pathways for Na(+) entry into the cells, whereas the Na(+)/K(+) pump (NKA) is the main Na(+) extrusion pathway and therefore is essential in maintaining the transmembrane Na(+) gradient. Phospholemman is an important regulator of NKA function (decreasing Na(+) affinity unless it is phosphorylated). Here we discuss the interplay between Ca(2+) and Na(+) in myocytes from normal and failing hearts.