The in vitro calcium uptake activity has been examined in fragments of sarcoplasmic reticulum, i.e. vesicles, obtained from hearts spontaneously failing in the canine heart-lung preparation. The rate of uptake was found to be less than that observed for vesicles from control hearts. If the vesicles were prepared from a failed heart that had been treated in vivo with ouabain, then the rate of calcium uptake was normal. In vitro additions of ouabain increased the rate of calcium uptake only with vesicles prepared from failing hearts. This effect of ouabain on calcium uptake by vesicles appears, therefore, to be specific for the defect causing depression of calcium uptake. No evidence could be found that the depression of calcium uptake is due to uncoupling of the pump adenosine triphosphatase. Calcium uptake and adenosine triphosphatase activity were found to be proportionately depressed in the failing heart and proportionately restored by ouabain.ADDITIONAL KEY WORDS adenosine triphosphatase sarcoplasmic reticulurn excitation-contraction coupling ouabain heart failure calcium uptake anesthetized dogs• The excitation-contraction (1, 2) coupling mechanism has long been suspected (3, 4) to be involved in heart failure. Ignorance concerning the mechanism of excitation-contraction coupling and inability to evaluate its state has, however, heretofore prevented any direct assessment of this possibility. Our present understanding of the importance of the sarcotubular calcium pump (5-8) in the operation of excitation-contraction coupling and our ability to isolate and investigate this pump has recently made it possible to determine if some abnormality of it is associated with heart failure. Briggs, Gertz and Hess, in a recent report (5), have suggested that the heart From the