<prompt> In patients who present with a penetrating chest injury, injury to the heart is most likely when the following physical signs isare present:HypotensionDistended neck veins.Decreased heart sound.Decreased venous pressure  <response>: Hypotension, increased venous pressure distended neck veins, and decreased heart 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, intracardiac injury is almost certain and operative intervention is mandatory. 