A 73-year-old man with a history of coronary artery disease and preserved left ventricular ejection fraction (55%) presents to the emergency department with acute substernal chest pain radiating to his left arm for 30 minutes. Vital signs on arrival are BP 148/88 mmHg, HR 98 bpm, RR 16, and temperature 37.0°C. Physical examination reveals diaphoresis and anxiety. The initial 12-lead ECG shows no acute ST changes. He is given immediate-release sublingual nifedipine for presumed angina. Within 5 minutes, his blood pressure decreases to 105/62 mmHg and heart rate increases to 115 bpm. The patient reports facial flushing but states his chest pain has worsened in severity. Troponin I is negative at presentation and at 3 hours. The patient denies taking any beta-blockers. Which of the following best explains the paradoxical worsening of angina despite blood pressure reduction?

1. A)Reflex sympathetic activation increasing myocardial oxygen demand without concurrent beta-blockadeGABARITO
2. B)Reduced aortic diastolic pressure leading to decreased coronary perfusion pressure
3. C)Direct negative inotropic effect of nifedipine causing cardiogenic shock
4. D)Coronary steal syndrome redirecting blood flow from stenotic to non-stenotic vessels
5. E)Drug-induced thrombotic occlusion of the coronary artery