In patients who present with a penetrating chest injury, injury to the hea is most likely when the following physical sign is present
Hypotension increased venous pressure (distended neck veins), and decreased hea 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, the intracardiac injury is almost ceain and operative intervention is mandatory.
Hypotension
Distended neck veins
Decreased hea sound
Decreased venous pressure
Cardio thoracic surgery  