A 70-year-old patient called his family doctor because of the increasing exercise-induced dyspnea and repeated fainting. He has arterial hypertension and prostatic hypertrophy in his medical history. On physical examination the doctor noted the distinct systolic murmur in the second right intercostal space that radiated to the neck, normal breathing sounds over the lungs and moderate edemas of the crura. The ECG showed sinus bradycardia 55/min with first degree atrioventricular block. Which of the following should be included in the management of this patient?

1) patient should be referred to the cardiologist with the suspicion of mitral insufficiency with the secondary heart failure;
2) patient should be referred to the cardiologist with the suspicion of aortal stenosis with the secondary heart failure;
3) because of the presence of first degree atrioventricular block and fainting in the medical history, the patient should have a pacemaker implanted;
4) transthoracic echocardiogram should be performed in order to confirm the valvular heart disease, and to assess its significance and the systolic function of the left ventricle;
5) 24h Holter ECG monitoring should be performed in order to diagnose syncope.
The correct answer is: