Table 1. The American Association for the Surgery of Trauma (AAST) Heart Injury Scale ¹ .

Grade	Description
I	Blunt cardiac injury with minor ECG abnormality (nonspecific ST or T wave changes, premature atrial or ventricular contraction or persistent sinus tachycardia)
	Blunt or penetrating pericardial wound without cardiac injury, cardiac tamponade, or cardiac herniation
II	Blunt cardiac injury with heart block (right or left bundle branch, left anterior fascicular, or atrioventricular) or ischemic changes (ST depression or T wave inversion) without cardiac failure
	Penetrating tangential myocardial wound up to, but not extending through endocardium, without tamponade
III	Blunt cardiac injury with sustained (>6 beats/min) or multilocal ventricular contractions
	Blunt or penetrating cardiac injury with septal rupture, pulmonary or tricuspid valvular incompetence, papillary muscle dysfunction, or distal coronary arterial occlusion without cardiac failure
	Blunt pericardial laceration with cardiac herniation
	Blunt cardiac injury with cardiac failure
IV	Penetrating tangential myocardial wound up to, but extending through, endocardium, with tamponade
	Blunt or penetrating cardiac injury with septal rupture, pulmonary or tricuspid valvular incompetence, papillary muscle dysfunction, or distal coronary arterial occlusion producing cardiac failure
	Blunt or penetrating cardiac injury with aortic mitral valve incompetence
	Blunt or penetrating cardiac injury of the right ventricle, right atrium, or left atrium
	Blunt or penetrating cardiac injury with proximal coronary arterial occlusion
	Blunt or penetrating left ventricular perforation
	Stellate wound with < 50% tissue loss of the right ventricle, right atrium, or of left atrium
V	Blunt avulsion of the heart; penetrating wound producing > 50% tissue loss of a chamber