Traumatic injuries to the heart and great vessels are among the most life-threatening conditions in trauma surgery, necessitating rapid diagnosis and intervention. These injuries result from blunt or penetrating mechanisms, each with distinct diagnostic and management challenges. Blunt cardiac injury (BCI) is often underdiagnosed, with presentations ranging from asymptomatic myocardial contusions to life-threatening chamber rupture. Key diagnostic tools include electrocardiography (ECG), serum troponin levels, and echocardiography. In contrast, penetrating cardiac injuries (PCI) frequently result in pericardial tamponade or exsanguination, requiring early detection via focused assessment with sonography in trauma (FAST) and emergent surgical intervention to improve survival. Great vessel injuries, including those affecting the aorta, pulmonary arteries, superior vena cava (SVC), and major aortic branches, carry high mortality. Blunt thoracic aortic injury, typically caused by rapid deceleration and most commonly affecting the aortic isthmus at the ligamentum arteriosum, is optimally managed with delayed thoracic endovascular aortic repair (TEVAR) in stable patients. Penetrating great vessel injuries demand immediate hemorrhage control through direct pressure, ligation, or endovascular intervention. A multidisciplinary approach involving trauma, cardiothoracic, and vascular specialists is essential for optimal outcomes. Early recognition, aggressive resuscitation, and timely surgical or endovascular intervention remain the cornerstones of effective management.