A 29-Year-Old Man Is Brought to the Emergency Department by His

A 29-year-old man is brought to the emergency department by his friend due to retrosternal chest pain for the past hour.  The patient is agitated and restless.  Temperature is 38.1 C (100.6 F) , blood pressure is 180/106 mm Hg in the right arm and 182/104 mm Hg in the left arm, pulse is 110/min, and respirations are 20/min.  Physical examination shows bilaterally dilated pupils, normal heart and lung sounds, and a nontender abdomen.  ECG shows sinus tachycardia with ST-segment depression in the precordial leads.  Chest x-ray reveals no parenchymal opacities or pleural effusion and a normal mediastinum and cardiac silhouette.  Cardiac enzymes are normal.  Sublingual nitroglycerin and benzodiazepine therapy relieve the symptoms.  Which of the following is the most likely cause of this patient's chest pain?

A) Acute pericarditis
B) Aortic dissection
C) Coronary artery thrombosis
D) Coronary artery vasoconstriction
E) Pulmonary infarction

Correct Answer:

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