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:

D. All of the above.

DISCUSSION: 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.