A 65-Year-Old Man Is Admitted to the Hospital with an Acute

A 65-year-old man is admitted to the hospital with an acute ST-segment elevation myocardial infarction.  The patient undergoes coronary angiography with stent placement in the left circumflex artery, and he is started on therapy with a beta blocker and antiplatelet agents.  On day 3 of hospitalization he experiences chest pain.  The pain, described as sharp and radiating to his neck and shoulders, is exacerbated by coughing and swallowing.  He has no shortness of breath, lightheadedness, or abdominal pain.  Temperature is 37.5 C (99.5 F) , blood pressure is 130/80 mm Hg, pulse is 90/min and regular, and respirations are 20/min.  The lungs are clear on auscultation.  There is no peripheral edema.  Which of the following is the most likely cause of this patient's chest pain?

A) Pericardial inflammation due to autoimmune reaction to necrotic tissue
B) Pericardial inflammation due to concomitant viral infection
C) Pericardial inflammation overlying the necrotic segment of myocardium
D) Recurrent thrombosis of the culprit coronary vessel
E) Thrombosis of a nonculprit coronary vessel

Correct Answer:

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