A 63-year-old man comes to the emergency department due to a 1-week history of progressively worsening shortness of breath and cough. The shortness of breath is exacerbated when the patient lies flat in bed; he has to prop himself up with 3 pillows to sleep well at night. He was treated for a myocardial infarction 2 weeks ago and had 2 stents placed in the left anterior descending artery. The patient's other medical conditions include long-standing hypertension and type 2 diabetes mellitus. Blood pressure is 120/80 mm Hg, pulse is 92/min, and respirations are 22/min. Pulse oximetry is 89% on room air. Physical examination reveals bilateral crackles at the lung bases and an S3. Which of the following is most likely present in this patient?
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