Which finding most strongly supports a diagnosis of pericardial tamponade?

• A. Pulmonary edema
• B. Wide pulse pressure
• C. Distended neck veins
• D. An early diastolic murmur

Answer: (C)

Tamponade narrows the heart’s ability to fill during diastole, causing a rise in upstream venous pressure and prominent venous congestion. Distended neck veins directly reflect this increased central venous pressure from the restricted filling, making it the strongest clue toward tamponade. Pulmonary edema would point to left-sided overload or failure, a wide pulse pressure fits conditions like aortic regurgitation, and an early diastolic murmur suggests regurgitant valvular disease rather than tamponade. While tamponade can accompany hypotension, muffled heart sounds, or pulsus paradoxus, the most characteristic sign among these is distended neck veins.