Cardiac injury often occurs in the "danger zone of cardiac injury" (the upper boundary starts from the clavicle, the lower boundary extends to the costal arch, and the lateral boundaries are the nipple lines), resulting from open or closed injuries. Therefore, it is commonly classified as penetrating injury and non-penetrating injury. Penetrating cardiac injuries are mostly caused by sharp objects such as bullets, shrapnel, or knives piercing the heart, while a few cases may result from violent inward displacement of fractured sternums or ribs. Additionally, iatrogenic injuries may occur due to cardiac or vascular surgeries, invasive catheter examinations, or imaging procedures. The most frequently injured cardiac sites, in order, are the right ventricle, left ventricle, right atrium, and left atrium. The primary manifestations are cardiac tamponade and/or hemorrhagic shock, with varying degrees of severity. Diagnosis is generally straightforward. Any penetrating wound in the cardiac danger zone of the chest wall, as well as wounds in the root of the neck, upper abdomen, chest, posterior chest wall, or mediastinum, should raise suspicion of possible cardiac injury. If a wound is present in these areas, particularly the precordial region, accompanied by rapid onset of grade III hypotension or grade III shock, the diagnosis of cardiac injury is almost certain. In any patient with thoracic or abdominal trauma, if the estimated blood loss does not match the severity of shock, or if there is no rapid response to sufficient blood transfusion, or if initial hypotension improves temporarily with volume replacement but soon recurs—even leading to cardiac arrest—it is likely due to cardiac tamponade. Given the urgency and severity of the condition, excessive diagnostic tests are unnecessary, and immediate surgical intervention is required upon diagnosis. Even if cardiac arrest has occurred within approximately 10 minutes, aggressive surgical resuscitation should still be attempted, as it can yield a high success rate. Due to resource limitations, autotransfusion of thoracic blood should be performed during surgery, followed by high-dose combined administration of effective antibiotics postoperatively.

1. Injuries occurring in the "cardiac injury danger zone," especially those in the precordial region, or iatrogenic invasive procedures.
2. Hemorrhagic shock or cardiac tamponade manifestations appear within a short period (minutes to hours).
3. No rapid blood pressure recovery after sufficient blood transfusion.
4. Initial stage [first stage] hypotension improves rapidly after volume replenishment but soon reappears, even leading to cardiac arrest.

bubble_chart Diagnosis

1. Has the aforementioned history of injury.
2. Exhibits grade III shock or pericardial tamponade manifestations within a short period.
3. No rapid blood pressure recovery after sufficient blood transfusion.
4. Initial stage [first stage]: Hypotension improves rapidly after blood volume replenishment but soon reappears, even leading to cardiac arrest.

bubble_chart Treatment Measures

1. Treat shock while preparing for surgery.
2. Emergency surgical treatment.
3. Prevent postoperative infection and tetanus.
4. Supportive and symptomatic treatment.
5. For cases combined with intracardiac structural injury, perform open-heart repair under extracorporeal circulation as needed. Manage according to extracorporeal circulation procedures.

1. Immediately transfer to the nearest hospital for emergency treatment.
2. Avoid excessive examinations.
3. Even patients with cardiac arrest should undergo aggressive surgical rescue.
4. For cases highly suspected of penetrating cardiac injury but lacking definitive evidence, hospitalize for observation for over 2 weeks, monitoring for delayed pericardial tamponade.
5. For cases combined with intracardiac structural rupture, perform open-heart repair under extracorporeal circulation as needed.

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bubble_chart Cure Criteria

1. Cure: The defect is completely repaired, cardiac function is restored to grade I or above, and physical labor can be resumed.
2. Improvement: The defect is completely repaired, but cardiac function is restored to grade II or below.