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I know this is caused by pressure on the heart which is inhibiting the right atrium to empty into the ventricle.

But i am uncertain on the cause of the actual vessel distention. My best guess would be that the heart is struggling to pump blood out so the aorta and other major arteries dilate to increase blood flow. This on top of the air pressure accumulating in the plural space from the tension pneumo is my best guess. However i could be wrong. Hope this helped.

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Q: What cause Jugular vein distension?
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