82-year-old male, with a history of HTN, HLD, and CAD, presents to your clinic with a six-month history of dyspnea on exertion. He states he is unable to walk as far as he used when exercising, and when he over exerts himself, he reports having some mild chest pain and feeling lightheaded. This resolves with rest and he denies any syncope with these events.
Metoprolol 50mg daily
Lisinopril 10mg daily
Simvastatin 30mg daily
BP – 158/97
HR – 62
RR – 13
O2% – 100%
General – WN/WD male in NAD
Pulmonary – CTA without adventitial breath sounds
CV – Soft S2 with murmur over right 2nd intercostal space
PV – carotid pulse is weak and has a slow rise, murmur is appreciated
Neuro – No focal deficits
- What is the next step in the management of this patient?
- After the next step, what important variables must you specifically assess?