1. A 65-year old male comes to the office due to shortness of breath with prolonged walking for the last few months. He has no symptoms at rest or at night. He had a myocardial infarction one year ago and was treated with bypass grafting nine months ago. The patient was smoking a pack of cigarettes per day but stopped after heart surgery. He is compliant with medications and currently taking metoprolol succinate, valsartan, rosuvastatin, aspirin, furosemide, and spironolactone. His blood pressure is 125/80 mmHg, heart rate is 70 beats/min, and respiratory rate is 20/min. Chest auscultation revealed S3 gallop and bilateral basilar rales. Pitting edema is noted in bilateral lower extremities. Echocardiography showed a dilated left ventricle with an ejection fraction of 25%. What would be the next step in the management of this patient?

A. Implantable cardioverter-defibrillator placement
B. Coronary angiography
C. The left ventricle assist device
D. Refer for a heart transplant

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