LM is a 92-year-old female with a

LM is a 92-year-old female with a past medical history of chronic kidney disease stage 4, diabetes mellitus, coronary artery disease, atrial fibrillation on Eliquis, Chronic obstructive pulmonary disease, heart failure, gout, hypertension, hyperlipidemia, hypothyroidism on oxygen 2L nasal cannula. Who presented to the emergency room with complaints of shortness of breath. On assessment, the patient denied chest pain, fever, chills, nausea, vomiting, diarrhea, abdominal pain and dizziness. In the emergency room, she was found to be in atrial fibrillation with RVR and heart failure. Describe the relationship between any disease and/or risk factors in PMH that may have contributed to the development of the problem (which disease likely developed FIRST that began the “domino effect?).

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