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Management of the Patient with Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

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Physical Examination

On physical examination, the patient has a blood pressure of 138/85 mm Hg, his heart rate is 65 bpm, his lungs are clear to auscultation, and his heart exam reveals a normal S1 and S2, no S3 or S4 gallop, and a 1/6 early systolic ejection murmur present in the right upper sterna border. An echocardiogram obtained two months ago for auscultation of a systolic murmur revealed mild aortic sclerosis but no significant valvular pathology.  The ejection fraction was 50-55% with mild hypokinesis of the distal anterior wall. His LDL-C was 65 mg/dl, Cr 1.1 mg/dl, and potassium 4.2 mmol/L.