An 82-Year-Old Woman Comes to the Emergency Department Due to Chest

An 82-year-old woman comes to the emergency department due to chest pain.  The pain began when the patient was vacuuming and "felt as if someone placed my chest in a vise."  The pain improved after resting for 30 minutes, but she called her daughter, who brought her to the hospital.  The pain began again while she was walking into the waiting room.  The patient also reports mild nausea, weakness, and lightheadedness.  She has a history of hypertension, for which she takes losartan, and a prior upper gastrointestinal bleed for which she underwent treatment for Helicobacter pylori.  She has hyperlipidemia but did not tolerate simvastatin in the past due to muscle aches.  The patient is a nonsmoker.  She drinks a glass of wine on social occasions.  She has a younger brother who recently underwent coronary artery bypass graft surgery.  Blood pressure is 152/92 mm Hg, pulse is 92/min, and oxygen saturation is 96% on room air.  The patient appears mildly uncomfortable.  Examination reveals jugular venous distension and diffuse lung crackles.  On cardiac auscultation, a low-pitched extra heart sound just after S2 is appreciated at the apex.  The abdomen is soft and there is trace lower extremity edema bilaterally.  ECG shows ST-segment depression in leads I, aVL, and V3-V6.  Which of the following medications should be avoided in this patient at this time?

A) Chewable aspirin
B) High-dose atorvastatin
C) Intravenous heparin
D) Nitroglycerin infusion
E) Oral metoprolol