A 54-year-old male presents to the emergency room complaining of chest discomfort that started while he was landing the Boeing 747 plane in the airport this morning. He felt some lightheadedness as he taxied the plane. This is the fourth attack of chest discomfort in the last 6 months. It used to respond well to nitroglycerin but the effectiveness of nitroglycerin decreased over the weeks. Over the months, he has had several visits to the emergency department for this reason. A nuclear stress test performed last month gave an indeterminate result. Serum troponin was elevated once but not after every episode of chest discomfort. He is a commercial pilot for a major airline. He smokes one pack of cigarettes a day but drinks occasionally, in his words, ‘only on special occasions’. Of the following, what is the most important step in the management of this patient?
