Sudden in Medicine / Internal Medicine — 62yo Man | Cardiology | SMLE Q#1794

A 62-year-old man was discharged from the hospital 4 days ago after treatment for an acute ST-elevation myocardial infarction. He has been taking all of his new cardiac medications as prescribed. Today he presents to the emergency department with sudden, painless swelling of his lips, face, and tongue that began 1 hour ago. He denies rash, wheezing, or difficulty breathing but speaks with a muffled voice. Vital signs: T 36.8 °C, BP 138/82 mmHg, HR 78/min, RR 16/min, SpO2 98% on room air. His current medications include aspirin, clopidogrel, high-intensity atorvastatin, metoprolol, and ramipril. Which of the following medications is the most likely cause of this patient’s presentation?