No jugular venous distension is present, he is tachycardic and irregularly irregular on cardiac exam without any murmurs. His lungs are clear to auscultation. The rest of his exam is normal.
His physical exam reveals no jugular venous distention (JVD), mild bibasilar rales on lung exam, his heart sounds are regularly irregular, and an S4 heart sound is present. His ECG is below.
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