Six Days After Being Admitted to the Intensive Care Unit

Six days after being admitted to the intensive care unit because of acute myocardial infarction, an 80-year-old man is evaluated for acute substernal chest pain and dyspnea. Coronary angiography on admission showed an occlusion in the left anterior descending artery, and a drug-eluting stent was placed successfully. The patient has a history of hypertension and type 2 diabetes mellitus. Current medications include aspirin, clopidogrel, metoprolol, lisinopril, and atorvastatin. His temperature is 37.2°C (99°F) , pulse is 112/min, respirations are 21/min, and blood pressure is 72/50 mm Hg. During evaluation, the patient becomes unresponsive and goes into cardiac arrest.  Despite appropriate lifesaving measures, there is no return of spontaneous circulation and she is pronounced dead.  Autopsy examination is performed, and the myocardial findings are shown in the image below. Which of the following most likely predisposed this patient to the observed cardiac findings?

A) Coronary atherosclerosis
B) Prolonged alcohol consumption
C) Recent viral infection
D) Recurrent bacterial pharyngitis
E) Repeated blood transfusions

Correct Answer:

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