Sydney Ringer would be overwhelmed today by the implications of his simple experiment performed over 120 years ago showing that the heart would not beat in the absence of Ca 2+ . Fascination with the role of Ca 2+ has proliferated into all aspects of our understanding of normal cardiac function and the progression of heart disease, including induction of cardiac hypertrophy, heart failure, and sudden death. This review examines the role of Ca 2+ and the L-type voltage-dependent Ca 2+ channels in cardiac disease.When Sydney Ringer (1) discovered the vital role of Ca 2+ in the heart, investigations took a leap forward and have continued unabated (2). Austrian scientist Otto Loewi, best known for his work on autonomic transmitters and discovery of "chemical vagusstoff," recognized the connection between digitalis and Ca 2+ in [1917][1918]. Although he always believed that Ca 2+ was the key to understanding life's processes, the Nobel Prize in Physiology and Medicine was awarded to Loewi and Sir Henry Hallett Dale in 1936 for their studies on neurotransmitters.Ca 2+ is the link in excitation-contraction (EC) coupling (Figure 1), which starts during the upstroke of the action potential (AP) and causes the opening of the L-type voltage-dependent Ca 2+ channel (L-VDCC). Interest in high-voltage-activated L-VDCCs began with biochemical and continued with molecular characterizations, culminating in the cloning of the pore-forming α 1 subunit and the auxiliary channel subunit α 2 /δ from rabbit skeletal muscle (3)(4)(5). Although the L-VDCC subunits are most abundant in fast skeletal transverse tubules, Ca 2+ influx is not required for contraction in skeletal muscle, unlike cardiac muscle, which requires Ca 2+ entry with each beat and triggers Ca 2+ release from the sarcoplasmic reticulum (SR) via Ca 2+ -release channels, e.g., ryanodine receptor 2 (RyR2). This amplifying process, termed Ca 2+ -induced Ca 2+ release (CICR) by A. Fabiato, causes a rapid increase in intracellular Ca 2+ concentration ([Ca 2+ ] i ) (from ∼100 nM to ∼1 µM) to a level required for optimal binding of Ca 2+ to troponin C and induction of contraction (2). There is a close correlation between activation of the L-type Ca 2+ current (I Ca,L ) and cardiac contraction. Contraction is followed by Ca 2+ release from troponin C and its reuptake by the SR via activation of the SR Ca 2+ -ATPase 2a (SERCA2a) Ca 2+ pump in addition to extrusion across the sarcolemma via the Na + /Ca 2+