His oxygen saturation is 88% on room air. He appears in mild distress, no jugular venous distension is present, he is tachycardic and regular without any murmurs. His lungs are clear to auscultation.
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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