Review Question - QID 213744

A 62-year-old man presents to the emergency department for weakness. He started having abdominal pain and has felt weak during this time frame. His wife thinks he is more confused. The patient has a past medical history of heart failure, several myocardial infarctions, a stroke, hypertension, diabetes, dyslipidemia, erectile dysfunction, bipolar disorder, and vascular claudication. The patient has a history of alcohol abuse and drinks 5 to 6 beers per day. The patient was recently seen by his primary care physician, started on several new medications, and had labs drawn that have not yet been reviewed. His temperature is 97.0°F (36.1°C), blood pressure is 164/89 mmHg, pulse is 130/min, respirations are 19/min, and oxygen saturation is 95% on room air. Physical exam is notable for a confused man. Cardiopulmonary exam reveals a rapid heart rate with minor bibasilar crackles. An ECG is performed as seen in Figure A. Which of the following most likely worsened this patient's presentation?