Shortness of breath and decreased exercise tolerance

Case One
A 73-year-old man is evaluated in the office for shortness of breath and decreased exercise tolerance for the past 3 days. He has no other medical problems, and his only medication is low-dose aspirin daily.
On physical examination, heart rate is 148/min and blood pressure is 118/68 mm Hg. The lungs are clear. Cardiac examination demonstrates tachycardia with no murmur. The electrocardiogram is shown.

Question:
Which of the following is most likely causing this patient’s symptoms? Work through the VINDICATE (possible diagnosis) format
Please describe your treatment plan, including tests, medications, labs etc, in an SBAR format:
Always do CBC, BMP. I would also add cardiac enzymes as well

 

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