We agree with the importance of a thorough physical exam in cases of cardiac tamponade, which can help lead to a quicker diagnosis. Two of these physical exam findings are pulsus paradoxus and anthem sign, which are illustrated in Tokuda’s comments on our earlier case report.1 In an era of medicine where diagnostic tools such as laboratory tests and radiological imaging are faster and easier to obtain, physical exam findings are often underutilized. In the nonurgent setting, the constellation of symptoms gathered by history as well as pertinent exam findings can increase your pre-test probability when cardiac tamponade is a consideration.