Soru

A $68$-year-old male is evaluated in the intensive care unit for abrupt-onset severe respiratory distress and hypotension. Four days ago, he was admitted with an acute ST-segment elevation myocardial infarction involving the inferior leads; he subsequently received a drug-eluting stent to the right coronary artery. His medical history includes hypertension and a $40$-pack-year smoking habit. Vital signs are temperature $36.9^\circ\text{C}$ ($98.4^\circ\text{F}$), blood pressure $82/54\text{ mm Hg}$, heart rate $118\text{/min}$, and respirations $28\text{/min}$. Oxygen saturation is $84\%$ on a non-rebreather mask. Physical examination reveals cool, diaphoretic extremities and elevated jugular venous pressure. Auscultation of the chest demonstrates bilateral crackles extending halfway up the lung fields with scattered expiratory wheezes. A new, loud holosystolic murmur is heard best at the cardiac apex with radiation to the left axilla. Which of the following is the most likely cause of this patient's current clinical deterioration?