The establishment of a left–right axis during vertebrate development is essential for coordinating the relative positions of the internal organs to ensure that they function appropriately. Studies in numerous model organisms have revealed differences in regulative mechanisms upstream of nodal signaling, a conserved pathway in left–right axis specification. This review will summarize the diverse pathways involved in the break of left–right symmetry and explore in depth the multiple roles of calcium in vertebrate left–right axis specification. Developmental Dynamics 237:3491–3496, 2008. © 2008 Wiley-Liss, Inc.