Right Ventricular Infarction practice

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Cardiovascularcommon

A 64-year-old man becomes hypotensive shortly after reperfusion of an inferior ST-elevation myocardial infarction. He is distressed but has clear breath sounds, a raised jugular venous pressure and cool extremities; the chest pain has largely settled. The ECG shows persistent ST elevation inferiorly and in lead V4R. Which one of the following is the most likely explanation?