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In tamponade, fluid around the heart raises intrapericardial pressure and prevents the ventricles from filling properly during diastole. That drop in end-diastolic filling reduces stroke volume and systolic blood pressure more than diastolic pressure, so the gap between systolic and diastolic pressures—the pulse pressure—narrows. Clinically you may also see hypotension, tachycardia, and muffled heart sounds, with pulsus paradoxus possible.

Loud S2 isn’t typical of tamponade (the heart sounds can be muffled), and hyperresonant percussion or decreased breath sounds point to lung or pleural pathology rather than pericardial tamponade.