A 58-year-old patient reports chest pain and difficulty breathing after missing their last three hemodialysis...

Missing dialysis leads to fluid overload, causing:

Pulmonary edema, evident by crackles on auscultation

Dyspnea and chest discomfort

Bradycardia is less likely; patients more often present with tachycardia due to volume stress. Fever would suggest infection (not stated here), and hypotension can occur later, but hypertension is more common in early fluid overload.