Mechanical Complications practice

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Cardiovascularmiddle twist

A 64-year-old man is recovering in hospital four days after an inferior ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. He suddenly becomes breathless and clammy, with a blood pressure of 86/54 mmHg and a new loud systolic murmur. The murmur is loudest at the lower left sternal edge and is accompanied by a palpable thrill; the lungs contain bilateral crackles. Which one of the following is the most likely diagnosis?