Na+ transport in the normal and failing heart - Remember the balance

In the heart, intracellular Na+ concentration ([Na+](i)) is a key modulator of Ca2+ cycling, contractility and cardiac myocyte metabolism. Several Na+ transporters are electrogenic, thus they both contribute to shaping the cardiac action potential and at the same time are affected by it. [Na+](i) is controlled by the balance between Na+ influx through various pathways, including the Na+/Ca2+ exchanger and Na+ channels, and Na+ extrusion via the Na+/K+-ATPase. [Na+](i) is elevated in HF due to a combination of increased entry through Na+ channels and/or Na+/H+ exchanger and reduced activity of the Na+/K+-ATPase. Here we review the major Na+ transport pathways in cardiac myocytes and how they participate in regulating [Na+](i) in normal and failing hearts. This article is part of a Special Issue entitled Na+ Regulation in Cardiac Myocytes. (C) 2013 Elsevier Ltd. All rights reserved.