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Heart ripped out refers to the act of literally ripping someone's heart out. I don't mean it in a metaphorical, hippie-dippie, "You broke my heart, Fredo" sort of a way. [1] I mean someone actually punches their hand into someone's chest, and rips out their actual friggin' heart. Sometimes the thing is still beating in their blood-soaked hands when the action takes place. Needless to say, this sort of gross form of misconduct is usually exclusive to the horror genre, though some action and sci-fi movies have employed the technique as well.

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  1. Yeah, that last bit is a paraphrased line from the end of The Godfather Part II. But then, you already knew that, didn't you?