Review Question - QID 204318

A 68-year-old man presents to the emergency room complaining of chest pain. The pain is located on the left side of his chest, and is worse with deep breathing and better with leaning forward. His past medical history is significant for a myocardial infarction one year ago. He also has hypertension; paroxysmal atrial fibrillation; and type 2 diabetes mellitus complicated by retinopathy, peripheral neuropathy, and chronic renal insufficiency. His medications include metoprolol, simvastatin, lisinopril, coumadin, and insulin. His temperature is 37 C (98.6 F), blood pressure 140/82 mm Hg, pulse 88/min, and respiratory rate 16/min. On physical exam, he has an S4 heart sound and a friction rub. Jugular venous pressure, pulmonary auscultation, and abdominal exam are within normal limits. His electrocardiogram (EKG) is shown in Figure A, chest radiograph in Figure B, and echocardiogram in Figure C. Initial laboratory results are as follows:
Sodium 136 mEq/L, potassium 5.6 mEq/L, bicarbonate 16 mEq/L, BUN 74 mg/dL, creatinine 3.9 mg/dL, glucose 225 mg/dL. ...