ID/CC: A 56years old man comes to see cardiologist because of an increased need for nitroglycerin patches in order to control his oppressive exercise induced chest pain(Angina).
HPI: In the past ,taking one tablet five minute before physical activity controlled his symptoms , now he has to take two tablets. the patient has continued to smoke two packs of cigarrettes day and is concerned that his cardiac condition is worsening because of his increased needs for medication.
PE: Obese male and B.P:normal.
LABS:CBC=Elevated hematocrit,Elevated glucose and Hypercholestremia
What is your treatment? and what is you discussion?