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A 72year old male presents to the Emergency Department for a cough. He reports several days of a dry cough and mild shortness of breath. Pulmonary exam is unremarkable. Cardiac exam is notable for muffled heart sounds. You obtain a chest-x-ray, which shows an enlarged cardiac silhouette. You suspect that the patient has a pericardial effusion and perform pulsus paradoxus to evaluate for cardiac tamponade.