Ca²⁺ has been well accepted as a signal that coordinates changes in cytosolic workload with mitochondrial energy metabolism in cardiomyocytes. During increased work, Ca²⁺ is accumulated in mitochondria and stimulates ATP production to match energy supply and demand. The kinetics of mitochondrial Ca²⁺ ([Ca²⁺]_m) uptake remains unclear, and we review the debate on this subject in this article. [Ca²⁺]_m has multiple targets in oxidative phosphorylation including the F1/FO ATPase, the adenine nucleotide translocase, and Ca²⁺-sensitive dehydrogenases (CaDH) of the tricarboxylic acid (TCA) cycle. The well established effect of [Ca²⁺]_m is to activate CaDHs of the TCA cycle to increase NADH production. Maintaining NADH level is not only critical to keep a high oxidative phosphorylation rate during increased cardiac work, but is also necessary for the reducing system of the cell to maintain its reactive oxygen species (ROS) —scavenging capacity. Further, we review recent data demonstrating the deleterious effects of elevated Na⁺ in cardiac pathology by blunting [Ca²⁺]_m accumulation.