Diabetes is commonly associated with an elevated level of reactive carbonyl species due to alteration of glucose and fatty acid metabolism. These metabolic changes cause an abnormality in cardiac Ca 2+ regulation that can lead to cardiomyopathies. In this study, we explored how the reactive α-dicarbonyl methylglyoxal (MGO) affects Ca 2+ regulation in mouse ventricular myocytes. Analysis of intracellular Ca 2+ dynamics revealed that MGO (200 µM) increases action potential (AP)-induced Ca 2+ transients and sarcoplasmic reticulum (SR) Ca 2+ load, with a limited effect on L-type Ca 2+ channel-mediated Ca 2+ transients and SERCA-mediated Ca 2+ uptake. At the same time, MGO signi cantly slowed down cytosolic Ca 2+ extrusion by Na + /Ca 2+ exchanger (NCX). MGO also increased the frequency of Ca 2+ waves during rest and these Ca 2+ release events were abolished by an external solution with zero [Na + ] and [Ca 2+ ].Adrenergic receptor activation with isoproterenol (10 nM) increased Ca 2+ transients and SR Ca 2+ load, but it also triggered spontaneous Ca 2+ waves in 27% of studied cells. Pretreatment of myocytes with MGO increased the fraction of cells with Ca 2+ waves during adrenergic receptor stimulation by 163%.Measurements of intracellular [Na + ] revealed that MGO increases cytosolic [Na + ] by 57% from the maximal effect produced by the Na + -K + ATPase inhibitor ouabain (20 µM). This increase in cytosolic [Na + ] was a result of activation of a tetrodotoxin-sensitive Na + in ux, but not an inhibition of Na + -K +ATPase. An increase in cytosolic [Na + ] after treating cells with ouabain produced similar effects on Ca 2+ regulation as MGO. These results suggest that protein carbonylation can affect cardiac Ca 2+ regulation by increasing cytosolic [Na + ] via a tetrodotoxin-sensitive pathway. This, in turn, reduces Ca 2+ extrusion by NCX, causing SR Ca 2+ overload and spontaneous Ca 2+ waves.