Apart from this, he has a past history of hypertension, hypercholesterolemia, and chronic renal impairment. He has history of self-medication with Panadol few times a week and admits of medication noncompliance. His current admission is due to acute onset of chest pain and shortness of breath leading to emergency admission to the rural hospital where he was diagnosed with acute anterior myocardial infarction and was treated with thrombolytic therapy. There was abatement of symptoms, and he was sent to the metropolitan hospital for coronary angiography and further investigations.
Mr. Walker understands that his disease is a result of atherosclerotic cardiovascular disease, which is caused by life-style associated risk factors. His diabetes mellitus, hypercholesterolemia, hypertension, and type 2 diabetes mellitus are interrelated to his dietary habits, perhaps obesity, and it in turn is causing chronic renal dysfunction, which may be further aggravated by his hypertension. His type 2 diabetes is an independent risk factor for his hypercholesterolemia, and both combined together would aggravate his atherosclerotic cardiovascular disease and deteriorate the outcome in terms of adverse cardiac events. Moreover self-medication and non-compliance to medications would also worsen the clinical picture. He also understands that smoking and alcohol use are risk factors for atherosclerotic cardiovascular disease, and they both may accelerate atherosclerotic cardiovascular disease and worsen his prognosis (Tacoy et al., 2008, 402-407).
Mr. Walker has been educated on the relationship between the kidneys and hypertension. His chronic renal disease will cause hypertension, and hypertension will contribute to the development of chronic renal disease. Given his baseline myocardial infarction, hypertension is major modifiable risk factors for atherosclerosis. Therefore, he was educated on the need for medication compliance and regularity of treatment (Zoccali, Mallamaci, and Tripepi, 2002, 381-386).
Mr. Walker has been educated that non-pharmacologic or lifestyle measures are important not only to prevent hypertension, but his overall condition of atherosclerotic cardiovascular disease, hypercholesterolemia, and diabetes, all will respond to such measures. He has been educated on basic dietary measures such as low-fat diet, low-salt diet, diet high in fruits and vegetables, and abstinence from alcohol would reduce his high blood pressure, hypercholesterolemia, blood sugar, and weight, which all together would reduce his risks of coronary artery disease (Chyun et al., 2003, 302-318).
Mr. Walker has been educated on physical activity and has been demonstrated what kinds of activity may be suitable for him. He has also been alerted about resumption of physical activity very slowly following his myocardial infarction. He has been told that regular exercise increases work capacity. Training increases exercise capacity by increasing both maximal cardiac output and the ability to extract oxygen from the blood. Although he appeared less motivated about doing a regular exercise program, it was stressed repeatedly to him that regularity and persistence in such a program will help him (Ignarro, Balestrieri, and Napoli, 2007, 326-340).
Mr. Walker has been given information on cessation of smoking since cigarette smoking is perhaps the most preventable known cause of CHD today, leading to more deaths