Case 1

A 67-year-old obese man presents with severe substernal chest pain. He also experiences nausea, vomiting, and profuse diaphoresis. He has had similar episodes in the past when climbing stairs, but they have always resolved with rest. Laboratory studies reveal elevated troponin levels. The patient's ECG is shown in the image. Heart catheterization fails to demonstrate blood flow through the posterior interventricular artery. ---- which of the following is the most likely inciting event in the pathogenesis of acute myocardial infarction in this man * A/ Coronary artery dissection B/ Coronary artery vasospasm C/ Plaque rupture D/ Thromboembolic disease E/ VIral infection