We present a report of a 28-year-old male patient who developed a left ventricular to right atrial communication associated with tricuspid insufficiency secondary to nonpenetrating cardiac trauma. The patient's heart block was clarified by serial observation of electrocardiograms and the use of HIS bundle electrocardiography. The patient's fistula was surgically repaired, and 20 months postinjury he is asymptomatic and pacemaker dependent. Echocardiography may aid in the early diagnosis of a left to right shunt and/or tricuspid insufficiency in the setting of possible cardiac trauma.