The diagnosis and management of blunt cardiac injury, formerly known as myocardial contusion, has challenged clinicians for decades. Caused primarily by motor vehicle collisions, significant blunt cardiac injury carries a high mortality rate. Yet no reliable diagnostic test exists to identify those patients at greatest risk for an adverse outcome. A literature search using the MEDLINE database was performed to compose a review of epidemiology, diagnostic intervention, and therapeutic approach. The results of the search indicate that, along with a high index of suspicion, utilizing a combination of electrocardiogram, troponin, and echocardiography for appropriate patients may improve the diagnosis, risk stratification and disposition of patients sustaining blunt cardiac injury.