A 62-Year-Old Man Comes to the Physician for Evaluation of Chest

A 62-year-old man comes to the physician for evaluation of chest and upper abdominal discomfort for the past 6 months.  He has noted the discomfort during his daily walks and sometimes at rest, especially after heavy meals.  His other medical problems include hypertension, type 2 diabetes mellitus, and gastroesophageal reflux disease.  His medications include metformin, aspirin, hydrochlorothiazide, and lisinopril.
The patient's blood pressure is 142/82 mm Hg and pulse is 74/min.  BMI is 33 kg/m².  His physical examination is remarkable for chronic venous stasis and 1+ swelling of both lower extremities.
The patient is referred for an exercise radionuclide stress test.  After 5 minutes on the Bruce protocol, he is able to reach 85% of maximum age-predicted heart rate.  His blood pressure at baseline is 148/88 mm Hg and is 142/86 mm Hg at peak exercise.  He complains of discomfort in both arms and his chest during the end of exercise, which resolves 5 minutes later during the recovery period.  ECG monitoring shows 2-mm horizontal ST-segment depression in leads II, aVF, and V4-V6 at peak stress with normalization at recovery.  However, myocardial perfusion images show no evidence of ischemia, and ejection fraction is calculated at 65%.
Which of the following is the most appropriate next step in management?

A) Add clopidogrel and nitroglycerin as needed
B) Evaluate for noncardiac cause of chest pain
C) Prescribe proton pump inhibitor
D) Reassure and follow up in 3-6 months
E) Refer for cardiac catheterization