All victims of blunt injury to the chest or precordium admitted to a Level I trauma center in a 1-year period were evaluated prospectively with two-dimensional echocardiography on the day of admission, serial determinations of creatine kinase (CK) and MB isoenzyme radioimmunoassay (CK-MB) over the first 24 hours, continuous electrocardiographic monitoring over at least the first day, and serial 12-lead electrocardiography (ECG) over the first 3 days. The patients were divided into four groups based upon the results of echocardiography. Group A (n = 35) had normal ECHO and ECG; Group B (n = 16), normal ECHO and abnormal ECG; group C (n = 14), ECHO showing abnormal wall motion and/or pericardial fluid; group D (n = 8), ECHO showing a nontraumatic valvular or wall motion abnormality. Nineteen patients required an operation under general anesthesia. Group C patients had significantly higher CK, CK-MB, numbers of associated injuries, and Injury Severity Scores; seven required invasive hemodynamic monitoring. No cardiac morbidity of general anesthesia was seen. We conclude that echocardiography is an important tool for diagnosis and triage which may be used to stratify a homogeneous patient population into groups with acute, chronic, and no cardiac disease. Cardiac injury occurs in a setting of multisystem trauma. Patients with normal echocardiogram and ECG on admission do not require intensive care monitoring.