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A 58-year-old man has had constant central chest heaviness for 70 minutes, radiating to his left arm, with sweating and nausea. The pain is unchanged by posture and unchanged by deep breathing. Blood pressure is 148/86 mmHg in both arms, the chest is clear on auscultation and oxygen saturation is 98% on room air. The electrocardiogram shows horizontal ST depression of 2 mm in leads V1 to V3, with tall R waves and upright T waves in those leads, and no ST elevation in any of the twelve leads recorded. Which one of the following best accounts for his pain and his electrocardiogram?
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