Blunt trauma to the chest and abdomen frequently results in cardiac injury. A wide spectrum of pathology can follow, including myocardial concussion and contusion, valvular disruption, and pericardial effusion and tamponade. Likewise, sequelae may be inconsequential or lead to sudden death, and may occur immediately at the time of trauma or be delayed by days to years. Despite the increasingly common occurrence of myocardial contusion there remains much confusion as to how the diagnosis is made. The various diagnostic studies utilized are frequently misinterpreted. The pathophysiology, clinical presentation, and a critical evaluation of the diagnostic tests used in the confirmation of this entity are reviewed, and an approach to the evaluation and management of these patients is presented.