A 54-year-old man comes to the physician for a 6-month history of progressively worsening shortness of breath on exertion. Around 6 months ago, he began feeling extra “winded” while doing errands and walking around a local mall. The past few months, he feels fatigued walking up two flights of stairs in his house. There is no chest pain. He has no symptoms at rest. He takes no medications. He has been smoking one-half pack of cigarettes daily for 36 years. His HbA1c is 5.6%. Blood pressure is 128/75. An baseline ECG shows no abnormalities. A resting echocardiogram shows an ejection fraction of 55%. Which of the following is the next best step in management?
A) Ambulatory ECG monitor
B) Carotid duplex ultrasonography
C) Exercise ECG stress test
D) Exercise echo stress test
E) Measure serum troponins
