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Investigation into the patient's clinical history further supported the final impression. These findings included jugular venous distention without audible precordial gallops, rubs, or clicks. Swan-Ganz catheter measures included right ventricular systolic pressure of 50-52 mmHg, right ventricular end-diastolic blood pressure of kidney stones 20-25 mmHg, pulmonary arterial pressure of 50/25 mmHg, and a pulmonary wedge pressure of 22-25 kidney stones mmHg. Echocardiogram showed a thickened pericardium, a distended inferior vena cava (IVC), and findings consistent with an estimated right atrial pressure of 20 mmHg. These findings indicate a kidney stones constrictive physiology of the heart, and the patient was referred for pericardial stripping. Liver function tests were normal except for elevated total bilirubin, lactate dehydrogenase, creatine kinase, and prothrombin time/partial thromboplastin time.
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