Heart trauma is a severe form of thoracic trauma with an incidence of 7–14%. Heart trauma can be either open or blunt, with the latter more prevalent during a disaster. Possible open heart injuries include: (1) pericardial injuries; (2) superficial myocardial and coronary vessels injuries; and (3) penetrating cardiac wounds. The variants of blunt heart trauma include: (1) heart concussion and contusion; (2) rupture of the heart wall and intracardiac structures; (3) rupture of cusps and cords of the heart valves; and (4) cardiac septa (i.e., post-traumatic heart lesions). The latter are characteristic of injuries caused by a fall, and/or a crushing event. The course of heart trauma is severe, and is complicated by the development of shock and catastrophic hemodynamic disorders due to the sudden occurrence of post-traumatic heart lesions and infarction. Thus, verifying cardiac trauma can be complicated. Diagnosing and assessing the severity of heart trauma requires the measurement of intra-arterial and central venous pressures, chest radiography, electrocardiography, pericardial puncture, echocardiography, magnetic resonance imaging, cardioangiography, and measurement of heart enzymes. One-hundred twenty-seven patients ages 2 to 42 years with open (92.1%) and blunt (7.9%) cardiac trauma were treated. Of these patients, 16.5% were children and teenagers. The challenges of treating heart trauma include simultaneously carrying out anti-shock treatment, surgical operation, and resuscitation measures. If post-traumatic heart lesions are diagnosed, surgical correction should be performed despite cardiac decompression. The use of cardiopulmonary bypass is essential.