Mr Orozco a 35 year old male, presents to the emergency room with complaints of shortness of breath and chest pain persisting for the past month. He rates his chest pain as 4/10 and is alert and oriented X 4. Mr. Orozco denies any allergies, medications, medical or surgical history, and has not previously sought medical care. Psychosocial, he admits to alcohol intake and frequent use of illicit drugs. Upon examination, Mr. Orozco exhibits distended neck veins, weak heart sounds, and findings consistent with fluid in the lungs and an enlarged heart on chest x-ray. Possible diagniosis?