A 60-year-old man has experienced angina on exertion for the past 6 years. A coronary angiogram...

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A 60-year-old man has experienced angina on exertion for the past 6 years. A coronary angiogram performed 2 years ago showed 75% stenosis of the left anterior descending coronary artery and 50% stenosis of the right coronary artery. For the past 3 weeks, the frequency and severity of the anginal attacks have increased, and pain sometimes occurs even when he is lying in bed. On physical examination, his blood pressure is 110/80 mm Hg, and pulse is 85/min with irregular beats. Laboratory studies show serum glucose, 188 mg/dL; creatinine, 1.2 mg/dL; and troponin I, 1.5 ng/mL. Which of the following is most likely to explain these findings? □(A) Hypertrophy of ischemic myocardium with increased oxygen demands (B) Increasing stenosis of right coronary artery (C) Fissuring of plaque in left coronary artery with superimposed mural (partial) thrombosis (D) Sudden complete thrombotic occlusion of right and left coronary arteries □ (E) Reduction in oxygen-carrying capacity owing to pulmonary congestion A 60-year-old man has experienced angina on exertion for the past 6 years. A coronary angiogram performed 2 years ago showed 75% stenosis of the left anterior descending coronary artery and 50% stenosis of the right coronary artery. For the past 3 weeks, the frequency and severity of the anginal attacks have increased, and pain sometimes occurs even when he is lying in bed. On physical examination, his blood pressure is 110/80 mm Hg, and pulse is 85/min with irregular beats. Laboratory studies show serum glucose, 188 mg/dL; creatinine, 1.2 mg/dL; and troponin I, 1.5 ng/mL. Which of the following is most likely to explain these findings? □(A) Hypertrophy of ischemic myocardium with increased oxygen demands (B) Increasing stenosis of right coronary artery (C) Fissuring of plaque in left coronary artery with superimposed mural (partial) thrombosis (D) Sudden complete thrombotic occlusion of right and left coronary arteries □ (E) Reduction in oxygen-carrying capacity owing to pulmonary congestion

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