In patients who present with a penetrating chest injury, injury to the heart is most likely when the following physical sign(s) is/are present:
Hypotension
Distended neck veins.
Decreased heart sound.
Decreased venous pressure
Hypotension, increased venous pressure (distended neck veins), and decreased heart sounds make up the classic Beck's 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.