New Angina in a Patient With Stable Coronary Disease

A 60-year-old man is referred to your cardiology clinic for an evaluation of chest pain. He has not seen a physician for several years prior to being evaluated by his new primary care doctor one week ago. During that visit, he mentioned episodes of sharp, left-sided chest pain that are fleeting in nature that he notices more with exertion. He does not recall any episodes of rest pain. He has a history of myocardial infarction at the age of 50 treated with stents and has not experienced any angina since then. The chest pain he describes is different from the pain he experienced with his MI. He is a former smoker and quit at the time of his MI. His only medication is aspirin, 81mg daily. He was noted to be hypertensive with a blood pressure of 152/90 mmHg with an otherwise normal physical exam. His PCP ordered an ECG (shown below) and checked labs including troponin prior to referring him. His TnT was <0.01 ng/mL. Lipid panel showed total cholesterol of 190 mg/dL, LDL 120 mg/dL, HDL 40 mg/dL.

Figure 1
Figure 1: New Angina in a Patient With Stable Coronary Disease

Which of the following is the next best step in the management of this patient?

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