Review Question - QID 214424

A 68-year-old man presents to the emergency department for anxiety. He has presented several times this past month for a similar chief concern and was sent home after an unremarkable workup each time. He states today he is anxious because he thinks his wife finds him unattractive. He has a past medical history of obesity, diabetes, and peripheral vascular disease. He denies chest pain, shortness of breath, nausea, vomiting, or any infectious symptoms. His temperature is 99.2°F (37.3°C), blood pressure is 150/95 mmHg, pulse is 92/min, respirations are 16/min, and oxygen saturation is 100% on room air. Physical exam is notable for an anxious obese man. Cardiopulmonary exam reveals minor bibasilar crackles. An ECG is performed as seen in Figure A. An ECG taken 2 years ago demonstrated normal sinus rhythm. The patient reports he feels much calmer in the ED. Which of the following is the most likely diagnosis?