A 55-Year-Old Man Is Brought to the Emergency Department Due

A 55-year-old man is brought to the emergency department due to severe substernal chest pain that is accompanied by sweating and mild dyspnea.  The pain started as midline chest discomfort several hours ago but then progressively worsened such that the patient could not fall asleep.  He received sublingual nitroglycerin in the ambulance without significant pain relief.  His medical history includes hypertension, type 2 diabetes mellitus, and hyperlipidemia.  ECG demonstrates normal sinus rhythm and ST-segment elevation in leads I, aVL, and V1-V4, with deep Q wave development over the next several hours.  Cardiac catheterization in this patient would most likely show which of the following?

A) Atherosclerotic plaque obstructing 50% of the coronary artery lumen, no thrombus
B) Atherosclerotic plaque obstructing 80% of the coronary artery lumen, no thrombus
C) Ruptured atherosclerotic plaque with fully obstructive thrombus
D) Significant coronary artery vasospasm causing flow obstruction
E) Ulcerated atherosclerotic plaque with partially obstructive thrombus

Correct Answer:

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