• Riccardo Scagliola, Sara Seitun, and Gian Marco Rosa.
• Division of Cardiology, Department of Emergency, Cardinal G. Massaia Hospital, Asti, Italy. Electronic address: risca88@live.it.
• Am J Emerg Med. 2022 Mar 1; 53: 222-227.

IntroductionAlbeit described since 1948, cardiac herniations still represent an under-recognized clinical entity in the general population, due to their difficult diagnostic detection and to a limited knowledge in clinical practice. This paper aims to provide an updated overview focusing on definition, clinical presentation and diagnostic work-up of cardiac herniations, as well as on further findings concerning prognoses and available therapeutic options.MethodsThis narrative review was performed by following the standard methods of the Cochrane Collaboration and the PRISMA statement. A Pubmed search was conducted using the following keywords (in Title and/or Abstract): ("cardiac" OR "heart") AND ("herniation" OR "hernia"). All available high quality resources containing information on epidemiology, etiopathogenesis, clinical findings, diagnostic tools and therapeutic strategies, were included in our search.ResultsCausative agents, location and the degree of haemodynamic impairment were found to play a pivotal role in defining the patient's natural history and prognostic outcomes, and in detecting potential associated clinical conditions which may significantly impact on first line decision-making strategy.ConclusionsCardiac herniations remain a rare and life-threatening pathological injury, whose knowledge is still very limited in clinical practice. Clinicians should be aware of such a clinical entity and of its wide spectrum of clinical manifestations, particularly in high-risk subsets of patients, in order to provide the most appropriate decision-making strategy and timely therapeutic approach.Copyright © 2022 Elsevier Inc. All rights reserved.

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