A 69-year-old male from home is brought to the emergency department complaining of substernal non-radiating chest pain along with diaphoresis. He experienced significant pressure in the anterior chest after eating dinner and while cleaning the kitchen. The patient has a history of hypertension, hyperlipidemia, poorly controlled diabetes, COPD, gout, hypothyroidism, and severe osteoarthritis. He has no significant surgical history but is waiting to see orthopedic surgery next week. The patient has a family history of coronary artery disease. He is a long-term heavy smoker, drinks two beers daily, but denies recreational drug use. BP is 158/93, HR is 79, saturating 95% on room air. Serial ECGs shows normal sinus rhythm with no ST or T wave changes. Labs are unremarkable except a glucose of 482 and an elevated creatinine of 1.2. Serial troponins are negative.

Which of the following is the next step in management?

• A) Urgent coronary angiogram
• B) Provide reassurance and discharge home with education on lifestyle changes
• C) Outpatient dobutamine stress echocardiogram
• D) Admit to the hospital and administer insulin
• E) Outpatient exercise stress test ECG