Review Question - QID 213695

A 33-year-old woman presents to the emergency department with shortness of breath. The patient has a past medical history of asthma and recently ran out of her inhaler. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for an overweight woman with parotitis, dorsal calluses on her hands, bilateral wheezing, and poor air movement on physical exam. The patient’s initial ECG is notable for sinus tachycardia. The patient is given an albuterol-ipratropium nebulizer and magnesium sulfate and is reassessed. Her repeat ECG is seen in Figure A. The patient states she still feels short of breath and feels weak. Which of the following is the most likely etiology for this patient’s current presentation?