Penetrating cardiac injury is still a diagnostic problem at this time. The authors want to show the breadth of problems on the case histories of two patients. It is important to classify the patients according to their risk group, and then to proceed. In each suspicion of cardiac injury we started with thoracotomy. It is an important "life endangering thoracotomy in emergency room". The hypotension with abdominal symptoms was started with laparotomy. Transdiaphragmatic pericardiotomy is a helpful adjunct in the decision as to whether proceed to median sternotomy. (Tab. 2, Fig. 3, Ref. 7.)