INTRODUCTIONSince the appearance of the classic work of Drury and Szent-Gyorgyi,' it has become clear that adenosine and related compounds play an important physiologic role in the cardiovascular system which is independent of the biologic role that these compounds play in cellular metabolism. Adenosine and ATP are released in the heart under physiologic and pathophysiologic conditionsz4 that are characterized by an altered oxygen supply to oxygen demand ratio. Furthermore, once in the extracellular space, adenosine and ATP can bind to specific cell surface receptors that mediate their effects on the coronary blood vessels, the specialized pacemaker and conducting tissues of the heart, and the contracting myocardial cells.Although ATP has been shown to exert pronounced effects in the mammalian heart, the mechanism of its action in general and the specific receptors mediating its actions in particular are not fully characterized. The cardiac effects of adenosine and ATP in the mammalian heart have been extensively discussed in recent reviews,s1o and, consequently, emphasis is given in the present text to some provocative aspects of these effects and the directions for future research.TABLE 1 summarizes the known cardiac effects of adenosine and ATP. The metabolic effect of adenosine, characterized by a shift of myocardial substrate utilization from fatty acids to carbohydrates, has been shown in a limited number of studies. Similarly, only a few reports have dealt with the ability of adenosine to reduce cardiac vascular and myocardial damage associated with reperfusion. Further studies are required to determine the ability of endogenous adenosine to exert these effects, the physiologic importance of these effects, and their implications for developing novel pharmacologic, therapeutic, and diagnostic agents.