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A 60-Year-Old Man Comes to the Office Due to Occasional

question 723

Multiple Choice

A 60-year-old man comes to the office due to occasional episodes of dizziness, usually when he tries to get up quickly. He had sustained an anterior wall myocardial infarction 4 months ago, and had emergent percutaneous revascularization of his proximal left anterior descending artery with placement of a stent. He has no chest pain, shortness of breath, palpitations, or syncope. He has been able to resume walking about 3 miles every day.
His home medications include aspirin, clopidogrel, rosuvastatin, carvedilol, sacubitril-valsartan, and spironolactone. Echocardiography performed 1 week ago showed a large area of dyskinesia in the anterior and anterolateral myocardial segments, with an ejection fraction of 25%. There was also mild mitral and tricuspid regurgitation present. These findings are similar to the earlier echocardiogram performed at the time of myocardial infarction.
His blood pressure is 112/62 mm Hg and pulse is 68/min. A soft, 2/6 holosystolic murmur is heard at the cardiac apex in the left lateral position. Lungs are clear to auscultation.
His ECG in the office shows sinus rhythm and Q waves in precordial leads.
Which of the following is the most appropriate next step in management?

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