Abstract-The heart is constantly under mechanical, metabolic, and thermal stress, even at baseline physiological conditions, and cardiac stress may increase as a result of environmental or intrinsic pathological insults. Cardiomyocytes are continuously challenged to efficiently and properly fold nascent polypeptides, traffic them to their appropriate cellular locations, and keep them from denaturing in the face of normal and pathological stimuli. ecause of alternative splicing of primary transcripts, posttranslational modifications, and the ability to assume multiple conformations that differ in activity, the proteome, in terms of its informational content, is considerably more complex than the genome and transcriptome. Thus, it is not surprising that controlling the quality of this information is essential for cell survival and function. Multiple layers of quality control for protein production and maintenance exist. After their initial synthesis, proteins targeted for the membrane and secretory pathways are modified, folded, and assembled in the endoplasmic reticulum (ER), whereas other cellular proteins may be synthesized and processed independently of the ER in the cytosol. Accordingly, there exist both ER-associated protein quality control (PQC) and ERindependent PQC. In both cases, molecular chaperones and the ubiquitin/proteasome system (UPS) play essential roles. In general, chaperones are responsible for protecting unfolded or partially folded nascent or mature proteins, with many chaperones participating in protein repair, 1 whereas the UPS is largely responsible for removing terminally misfolded proteins permanently, thereby preventing misfolded proteins from accumulating in the cell. 2 Although the first lines of defense rest in the "proofreading" of the primary DNA and RNA sequences, the cell has evolved multiple layers of control at the posttranslational level as well, and nascent proteins are subject to rigorous surveillance as they are synthesized on the polysomes. Although small-and medium-sized proteins often can assume their correct tertiary and quaternary conformations spontaneously, the majority of proteins cannot and depend on the help of and interaction with other proteins to fold correctly. The complete sequence is often necessary for assuming the correct conformation, but the linear process of protein synthesis presents unfinished proteins to the cellular environ-