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increases the force of cardiac contraction by direct action independent of innervation acts by inhibiting the sodium potassium pump the pump transports three sodium ions out of the cell and brings two potassium ions into the cell against the concentration gradient using ATP energy inhibits the pump by binding to the allosteric site this inhibition causes a buildup of intracellular sodium ions increased intracellular sodium activates the sodium calcium exchanger the sodium calcium exchanger removes three intracellular sodium ions in exchange for one extra cellular calcium ion this builds up concentration of intracellular calcium the excess calcium is taken up by sarcoplasmic reticulum which leads to increased cardiac contractility