Thoracic injuries can always involve cardiac structures. If the heart is affected, penetrating or blunt injuries need urgent treatment. An unstable cardiac situation with shock symptoms is life-threatening. The diagnostic method of choice is ultrasound examination. This can show pericardial effusion, enlargement of cardiac chambers, wall motion changes and intracardiac defects. Pathologic ultrasound and ECG findings or abnormal enzyme values arising after blunt traumas need intensive care monitoring. Surgical interventions should be done immediately by the first surgeon involved: time should not be wasted by sending patients to special units, as extracorporal circulation is seldom needed. If it is necessary treatment should be carried out by a cardiac surgeon. Between 1989 and 1990 seven patients with thoracic trauma and heart involvement were operated on at the University of Ulm. The indications applied and results achieved are discussed with reference to the literature.