A 55-year-old male presented to urgent care with a chief complaint of coughing, shortness of breath, wheezing, chest palpitations, and dizziness for the past 2 days. The patient denied chest pain. He has a significant past medical history of diabetes mellitus II and takes metformin 500 mg once a day.
The patient’s blood pressure is 88/60 mmHg, heart rate is 115, O2 sat 98%, weight 275 pounds, BMI 50.3. In addition:
- General: alert and oriented X3
- Lungs: CTAB
- Cardiovascular: tachycardic and regular without murmur, rub, or gallop
- Abdomen: soft and non-tender, no pulsatile mass
- Ext: 1+ pitting edema bilaterally in shins and ankles, pulses are equal and 2+ in all extremities
View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.