Introduction: Nowadays penetrating cardiac trauma has increased and is one of the important causes of mortality in patients with sharp chest trauma. Frequently death occurs in prehospital era. Routine approach for diagnosis of those patients who are referred alive to the hospital are clinical and paraclinical findings so due to take a long time, they can be life threatening. With early diagnosis and treatment, improvement up to 70 – 80% is predicted.

Case Report: In this report 4 patients with stab wound to the chest and heart are presented that were referred to Mobasher hospital in 2005 and 2006. There seen several non specific signs and symptoms suggestive to cardiac injury in two and clinical presentation were infavor to cardiac injury in another ones. With careful clinical examination specially about anatomical location of the chest penetrating trauma and evaluation of tract of sharp object in the chest wall and proximity to the heart, early surgical exploration through minithoracotomy was done and they treated after diagnosis of cardiac rupture.

Conclusion: It seems in patients with penetrating chest trauma, if finger examination of tract of the wound revealed direct penetration to the pleural cavity and had proximity to the heart, there is no need further work up and in clinically unstable patient, exploratory anterior minithracotomy through intercostal space 4th or 5th and in stable patient , thoracoscopy or minithoracotomy is recommended.