Calcium ion (Ca++) plays a central role in excitation-contraction coupling of both cardiac and vascular smooth muscles and have important functional interactions with other cations, including sodium, potassium, and magnesium. Ca++ transients associated with contraction-relaxation cycles of the heart and vasculature can now be recorded directly by use of aequorin, a bioluminescent protein that emits light when it combines with Ca++. After microinjection or chemical loading of aequorin into the sarcoplasm, light output provides an index of intracellular [Ca++]. In cardiac muscle, intracellular Ca++ increases more quickly than tension and decreases toward basal levels by the time peak tension is reached. The calcium transients of working myocardium in both human subjects and other mammalian species appear to be dominated by the release and uptake of Ca++ from intracellular stores under all conditions studied. Drugs and disease states produce marked changes in the amplitude and time course of the Ca++ transient and the corresponding contractile response. In vascular smooth muscle, there are stimulus-specific patterns in intracellular Ca++ associated with tonic contractions. Although Ca++ is related to tension development, the relationship appears to be more complex than that in cardiac muscle. As a result, tension development cannot be used as an index of free Ca++ levels in vascular smooth muscle. Selection of the most effective therapy to reverse a tonic contraction in states of spasm or hypertension may depend on the specific stimulus that caused the increased tone.