A patient assessment reveals distended neck veins, pulsus paradoxus, and decreased systolic pressure. What condition is this assessment most consistent with?

The assessment findings of distended neck veins, pulsus paradoxus, and decreased systolic pressure are most consistent with cardiac tamponade. In this condition, fluid accumulates in the pericardial space, leading to pressure on the heart and hindering its ability to pump effectively.

Distended neck veins indicate increased venous pressure due to impaired filling of the heart. Pulsus paradoxus, which is a notable decrease in systolic blood pressure during inspiration, further indicates that there is significant pressure on the heart affecting blood flow dynamics. The decreased systolic pressure reflects the heart's inability to maintain adequate output due to the external compression from the fluid.

In contrast, heart failure typically presents with signs such as fluid overload but does not necessarily involve pulsus paradoxus or the specific pattern of neck vein distention due to external compression. Pneumothorax can cause hypotension and respiratory distress but usually does not lead to neck vein distention or pulsus paradoxus. Aortic dissection is characterized more by severe chest pain and a difference in blood pressure between arms rather than the classic signs associated with cardiac tamponade.