A sailor's heartbreak

A 24-year-old sailor describes dyspnea in the setting of substantial weight gain, where the degree of weight gain and the time course suggest that this is a subacute process and the differential diagnosis is broad and includes cardiac, pulmonary, hepatic and renal dysfunction. The sailor had evidence of fluid on the pleural and peritoneal spaces and according to the results of chest radiography, pericardial effusion as well.