A 74-year-old Caucasian male presents to the emergency room with complaints of shortness of breath during exertion and while lying flat. He underwent mitral, aortic, and tricuspid valve replacement one month ago. Vital Signs: Temperature: 99 °F (37.2 °C) Heart rate: 89 beats/min Blood pressure: 148/105 mm Hg Respirations: 19 breaths/min Oxygen saturation: 89% on room air Physical Examination: Anxious elderly male with scleral icterus (jaundice). Cardiac auscultation: Normal S1, S2 with a holosystolic murmur heard best at the apex in the left lateral decubitus position. Laboratory Findings: Low hemoglobin Elevated LDH Elevated indirect bilirubin Decreased haptoglobin What is the most likely diagnosis in this patient?
