<prompt> In patients who present with a penetrating chest injury, injury to the hea is most likely when the following physical sign is presentHypotensionDistended neck veinsDecreased hea soundDecreased venous pressure  <response>: Hypotension increased venous pressure distended neck veins, and decreased hea sounds make up the classic Becks triad associated with cardiac tamponade. If these three findings are present in a person who has a penetrating chest wound, the intracardiac injury is almost ceain and operative intervention is mandatory. 