Answer: D

Reasoning:  
• Levine’s sign (clenched‐fist over the sternum) is a classic physical gesture seen with ischemic chest pain of myocardial infarction [Marcus, 2007, PMID 17208083].  
• Kussmaul’s sign (paradoxical rise of JVP on inspiration) occurs in right-ventricular infarction, which complicates many inferior MIs [Dubé, 2021, PMID 33709353].  
• Marked sinus bradycardia is characteristic of inferior-posterior MIs via the vagal (Bezold-Jarisch) reflex; it is uncommon in anterior-wall infarction, where sympathetic drive usually produces normal or elevated heart rate [Koren, 1986, PMID 3751860].  
• Elevated jugular “a” waves can appear if the right ventricle becomes stiff (e.g., RV infarct), so they may be present in some MI patients.  

Thus “bradycardia in case of infarction of anterior portion of heart” is the exception.