1) Calcium overload - too much intracellular calcium
2) Rate of efflux of calcium through pumps - if calcium is not removed from the cell quickly enough
3) Impaired sarcoendoplasmic reticulum calcium ATPase (SERCA)- this channel in the myocyte pumps calcium from the cytoplasm of the cell into the endoplasmic reticulum.
4) TN-C binding affinity - TN-C (troponin C) is a protein that affects the myosin-actin fibers of the heart. When calcium binds, it triggers contraction of the heart. If calcium binds to easily, relaxation will become more difficult.