Fifty-four patients who survived a penetrating cardiac injury were assessed for late cardiac complications. The mean follow-up after injury was 23 months. Clinical history and physical examination suggested cardiac complications in nine patients (17 per cent). Electrocardiogram was abnormal, but usually not diagnostic, in 17 (31 per cent). Routine two dimensional Doppler echocardiography revealed abnormalities in 17 (31 per cent). Ten patients (19 per cent) had valvular or septal defects. Other abnormalities included pericardial effusion, ventricular and septal dysfunction, and ventricular dilatation. Although it is impossible to determine how many of these abnormalities were post-traumatic, it seems that the incidence of late sequelae of cardiac injuries is high, and it is recommended that routine late follow-up of these patients should be done. Assessment should include routine echocardiograms.