Patients complaining of chest pain after a traumatic event represent a diagnostic challenge for the cardiologist. These patients can definitely escape from common diagnostic tests (particularly ECG and markers of myocardial lysis) that may guide the cardiologist, mostly because symptoms are attributed to the trauma itself. On the other hand, if blunt cardiac injury is suspected (involving coronary arteries, aorta, pulmonary trunk, pericardium, myocardium or valves), the selection of the most appropriate diagnostic and therapeutic tools (i.e. antithrombotic therapy) should also consider trauma involvement of other organs. We here describe two emblematic cases as examples of the challenges that diagnosis and treatment of cardiac injury can bring.