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A young lady with hypotension and engorged neck veins

A 25-year-old woman presented to us with history of breathlessness. The lady had noticed progressively increasing fatigue in the past six months and had a sense of generalized weakness. Over the past week or so she had been unable to do even routine chores at home and had been breathless since the past two days. The dyspnoea increased with lying down. She denied any history of fever.

She appeared pale, had dry skin and sparse pubic and axillary hair. Her neck veins were engorged. She had a pulse rate of 86/min, blood pressure of 76/40 mm Hg. Pulsus paradoxus was absent. Her chest was clear and heart sounds were distant.

What is the Possible Diagnosis?

The presentation of the case suggests a ...

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