A patient has muffled heart sounds, dull chest pain, dyspnea, tachycardia, cardiomegaly, pulsus paradoxus, jugular venous distention. Which condition does the patient likely have?

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Fluid accumulating in the pericardial sac causes these findings. When fluid builds up around the heart, muffled heart sounds occur because the sound is dampened by the surrounding fluid. Dyspnea and chest pain come from the heart’s impaired ability to fill and pump effectively as the fluid distends the pericardial space. The heart may respond by beating faster (tachycardia) to maintain output. A larger silhouette on imaging (cardiomegaly) can be seen when there is a sizeable pericardial effusion. Jugular venous distention reflects higher pressures in the right heart due to restricted venous return. Pulsus paradoxus can appear when the effusion is large enough to impede filling on inspiration, a sign that can accompany evolving tamponade, but the core pattern here—fluid in the pericardial space with these objective signs—most consistently fits pericardial effusion.