A 66-year-old man comes to the physician because of a 2-month history of worsening shortness of breath that now has transitioned to him experiencing difficulty climbing a single flight of stairs. He sleeps propped up on two pillows to avoid waking up gasping for air. He also describes episodes of waking up at night feeling like he cannot breathe, which improve after sitting up for several minutes. He has no symptoms at rest. He denies chest pain. He has a 20-year history of hypertension managed with lisinopril. A resting ECG shows a left bundle branch block. Which of the following is the next best step in management?
24-hour ambulatory ECG monitoring
24-hour esophageal pH monitoring
Exercise ECG stress test
Exercise echocardiographic stress test
Upper endoscopy
24-hour esophageal pH monitoring
Exercise ECG stress test
Exercise echocardiographic stress test
Upper endoscopy
