Tiotropium bromide, a long acting muscarinic receptor antagonist triggers intracellular calcium signalling in the heart.

•Anti-muscarinics have been associated with increased cardiovascular risk in chronic obstructive pulmonary disease (COPD).•Tiotropium bromide results in detrimental calcium signalling in whole heart models, observed with increased infarction.•The effects of Tiotropium bromide are reversed with L-type Ca2+ channel and CaMKII inhibitors.•Anti-muscarinics such as Tiotropium bromide may result in adverse cardiac effects without affecting cardiac function.•Further tests should be used to monitor COPD patients using anti-muscarinics for adverse cardiovascular effects.