[Energetics of ionic behavior in heart muscle contraction. Physiologic and physiopathologic aspects]

It is widely accepted that the ionic movement across the different membrane systems (i.e. sarcolemma, sarcoplasmic reticulum, mitochondria), plays a major role on heart muscle metabolism. On the other hand, neither the relative role nor the associated energy expenditure of those mechanisms have been definitively established. Biochemical and biophysical measurements of the different ion exchange mechanisms, have provided data leading to the postulation of different models for both resting and active metabolism of the heart muscle. The present work analyzes, from an energetic standpoint, available biochemical and biophysical data from the literature calculating the range of energy expenditure that should be attributable to each mechanism. Sodium, potassium and calcium movements during either resting and/or active state are particularly analyzed and the fractional role of various organelles (sarcolemma, sarcoplasmic reticulum and mitochondria) discussed. From this analysis and the known amount of energy released (or the amount of oxygen consumed) by the muscle it is possible to determine whether there is enough energy for a given model of ionic exchange during the excitation contraction process. In addition to this analysis a comparatively short review of energetic studies performed under pathological conditions is also presented. In particular, the pathological conditions analyzed are those with an energetic compromise such as heart hypertrophy, ischemia and anoxia in which the alteration of ionic transport mechanisms seems to be playing a major role.