A 72-Year-Old Man Comes to the Physician Because of a 2-Month

A 72-year-old man comes to the physician because of a 2-month history of intermittent retrosternal chest pain and tightness on exertion. He has type 2 diabetes mellitus, osteoarthritis of the right hip, and hypertension. Current medications include insulin, ibuprofen, enalapril, and hydrochlorothiazide. Vital signs are within normal limits. His troponin level is within the reference range.  He undergoes dobutamine infusion with simultaneous cardiac imaging.  The following is seen:Before infusion: normal left ventricular contractility, ejection fraction 60%During infusion: decreased apical contractility, ejection fraction 45%Five minutes after infusion: normal left ventricular contractility, ejection fraction 60%Which of the following best explains the observed findings?

A) Coronary artery occlusion due to plaque thrombosis
B) Coronary artery vasospasm
C) Focal myocardial fibrosis
D) Normal myocardial contractile response
E) Supply-demand mismatch due to fixed coronary stenosis

Correct Answer:

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