Q. A 65-year-old male was admitted through the emergency department last night with complaints of weakness, a productive cough, abdominal pain, and nausea. On admission, the patient also reported shortness of breath (dyspnea) on exertion, and a two-week history of swelling (edema) in his ankles bilaterally. He denied any history of chest pain. The patient has a 40-year history of smoking 1 to 2 packs of cigarettes per day, and excessive daily alcohol consumption. His medical history is significant for hypertension, hyperlipidemia, Type II diabetes, chronic kidney disease, and gout. He is currently being treated with captopril, furosemide, lovastatin, insulin on a sliding scale, and a daily aspirin. A nephrology consult was ordered and chronic renal dialysis has been recommended. On physical examination this morning, his blood pressure is 170/100 mm Hg, heart rate 85/min, respiratory rate 20/min, and oxygen saturation is 94 percent on room air. Auscultation of his chest demonstrates bibasilar crackles in both lung fields. An electrocardiogram (EKG) was just completed (see image), and his morning labs are still pending. What is the most likely underlying etiology of the abnormal findings seen on his EKG?