This 2-year retrospective study of penetrating heart injury comprises 125 hospitalized patients (HP) (stab wounds) and 407 who died before arrival (DBA) (23 bullet, 384 stab wounds). The cardiac penetration sites were related approximately to the location of the entrance wound. The incidence of injury to respective intrapericardial structures related to their anatomic vulnerability; coronary artery transection was uncommon, however. Aortic lacerations caused rapid death (93% were DBA), followed by those breaching the left ventricle; atrial wounds comprised a greater proportion in HP than DBA series. Cardiac tamponade was more than twice as common in HP than DBA cases. Above all traditional signs, a high index of suspicion was an essential element in diagnosing heart injury; all such cases underwent thoracotomy without delay. Mortality results were: 14.4% for operating theater (OT) and 87.5% for emergency room (ER) thoracotomies. Prognosis amongst HP was worst for aortic (60% mortality) and best with right ventricular injury (7.5%). A 'salvage rate' of 17.1% overall, or 17.9% for stab wounds, was recorded.