A 57-year-old female with renal insufficiency has been on dialysis fo
r thirteen years, but has failed to make her last two appointments. She
presents to the emergency room in obvious distress with a blood pressure
of 85/40 and jugular venous distension. Cardiac auscultation reveals no
murmurs, thrills, or heaves. Her heart rate is rapid, at 108 beats/min
, and the peripheral pulses are thready. Pulsus paradoxus is present,
but Kussmaul's sign is absent. Echocardiography reveals the presence
of a small heart. Which of the following is the most likely diagnosis?
A. Cardiac tamponade
B. Constrictive pericarditis
C. Congestive heart failure
D. Myocardial infarct
E. Restrictive cardiomyopathy