A frail 95-year-old patient was brought into the emergency department with poor oral intake and increasing lethargy for 5-days. She is legally blind, bed-bound for multiple years. She developed fever and cough at home and had tested positive for SARS-CoV-2 virus at the time of symptoms onset 5-days ago. On examination, she was dehydrated. She had bilateral basal crackles. SPO2 was 93% on room air. BP 120/70 HR 75 but irregular T 37.8. Lab investigations revealed
# Hb 14.5 WBC 18,700 PMN 16,600 Plts 214,000
# Cr 195 eGFR 20 Na 156 K was hemolyzed
# CRP 276
# D-Dimer 80
# Tn-T 178
Her 12-lead EKG is shown below. Why is the pulse irregular?
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