<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 65-year-old man is brought to the emergency department with central chest pain for the last hour. He rates his pain as 810, dull in character, and says it is associated with profuse sweating and shortness of breath. He used to have heartburn and upper abdominal pain associated with food intake but had never experienced chest pain this severe. He has a history of diabetes, hypertension, and hypercholesterolemia. His current medication list includes amlodipine, aspirin, atorvastatin, insulin, valsartan, and esomeprazole. He has smoked 1 pack of cigarettes per day for the past 35 years. Physical examination reveals: blood pressure 9468 mm Hg, pulse 112min, oxygen saturation 95 on room air, and BMI 31.8 kgm2. His lungs are clear to auscultation. An electrocardiogram ECG is done and shown in the picture. The patient is discharged home after 3 days on aspirin, clopidogrel, and atenolol in addition to his previous medications. He is advised to get an exercise tolerance test ETT in one month. A month later at his ETT, his resting blood pressure is 14586 mm Hg. The pre-exercise ECG shows normal sinus rhythm with Q waves in the inferior leads. After 3 minutes of exercise, the patient develops chest pain that is gradually worsening, and repeat blood pressure is 12162 mm Hg. No ischemic changes are noted on the ECG. What is the most appropriate next step?? A: Continue exercise since ECG does not show ischemic changes, B: Repeat exercise tolerance testing after one month, C: Stop exercise and order a coronary angiography, D: Stop exercise and order a pharmacological stress test, E: Stop exercise and order an echo stress test,  <response>: This is a question about the management of a 65-year-old man with a history of diabetes, hypertension, hypercholesterolemia, and smoking who presented with chest pain and ECG changes concerning for an acute coronary syndrome. He was treated and had an exercise tolerance test a month later that was concerning for ischemia. The key points from the stem are:- 65-year-old man with cardiac risk factors presenting with typical anginal chest pain and ECG changes concerning for acute coronary syndrome. - Was treated and had an exercise tolerance test a month later.- During ETT, he developed chest pain and blood pressure drop after 3 minutes of exercise, but no ischemic ECG changes.The correct next step would be to stop the exercise test due to his symptoms and blood pressure response, and proceed directly to coronary angiography to evaluate for obstructive coronary artery disease. Continuing exercise without ECG changes could be dangerous. Repeat testing in a month if initial test is equivocal, but his initial test was clearly positive for ischemia based on symptoms and blood pressure response. Stress testing with imaging or pharmacologic stress could be done, but angiography is the gold standard test once there is a high probability of obstructive disease, as in this patient.C: Stop exercise and order a coronary angiography 