"Tonic" and "phasic" mechanisms in the regulation of myocardial contractility.

Myocardial contractility can be regulated by two types of control mechanism. A "tonic control mechanism", which allows the heart to respond to sustained changes in circulatory dynamics, appears to operate through changes in the structure of various constituents of the myocardium, best understood of these being changes in the myosin molecule that cause alterations in both myosin ATPase activity and contractility. Beat-to-beat changes in myocardial contractility are affected by a "phasic control mechanism" that involves changes in at least five calcium fluxes in the myocardium. The effects of catecholamines, many of which appear to be mediated by cyclic AMP, can be understood in terms of the modification of several of the calcium fluxes involved in the phasic control of myocardial contractility.