A 68-yeаr-оld mаle presents tо the ER due tо increаsed WOB. The following information is obtained: History of COPD, hypertension, and atrial fibrillation; 4 kg weight gain in three days; BS with crackles throughout and wheezing in the upper airway; BNP 150 pg/mL; BP 180/95 mmHg, HR 128 and irregular, RR 30 BPM, Temp 98.8° F (37.1° C); SpO2 84% on a 50% Venturi mask. What is the most likely etiology?
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