A 58-year-old man presents to the emergency department with acute onset dyspnea and pleuritic chest pain. He had undergone knee arthroscopy 10 days ago. Vital signs show heart rate 112/min, BP 128/82 mmHg, RR 24/min, SpO₂ 92% on room air. His ECG is shown in the diagram. The pattern marked **B** (S1Q3T3 with RV strain pattern) is noted. Which of the following best describes the pathophysiological mechanism underlying this ECG finding in this clinical context?
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