Heart sounds are distant or muffled, murmurs are inaudible, and the precordial impulse conspicuous for itsabsence in the newborn or infant who has impending tamponade (185,189,192,196,199). The patient may havemarked hepatomegaly and diminished peripheral pulses (185,192,198). Stenotic murmurs may be heard when thetumor mass compresses cardiac chambers or great vessels (195,198). The newborn may present with cyanosis fromcompression of thepulmonary parenchyma (185,199) or from right-to-left atrial shunting (195).
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