Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: patient recorded as having no known allergies to drugs attending: chief complaint: transfer from for cardiac cath major surgical or invasive procedure: cardiac cath with stenting endotracheal intubation cardioversion central line placement history of present illness: year old woman with h/o anemia angiodysplagia-related gi bleed, h/o colon cancer, cad s/p anterior mi , resulting in depressed ef (35%) who was transferred from hosp for cardiac catherization. . recent relevant history: pt had an anterior mi on and was treated medically at nebh. she did not undergo cardiac catherization at that time. tte showed lvef=35% with severe hypokinesis of the apex infero-apically to antero-apically. there was akinesis of the distal septum, about halfway to the apex, including the apex. there was no ar, 2+ mr, 2+ tr, with pa pressures between 70 and 75mmhg. . pt was d/c'd to a cardiac rehab where she had persistant chest discomfort, sob, palpitations with nausea, and was re-admitted to for evaluation on . there, mi was ruled out by cardiac enzymes and pt's symptoms were determined to be likely related to mild chf along with anxiety. pt was diuresed, then sent back to rehab with medication adjustments. back at the rehab, patient continued to have vomitting, chest tightness, and luq pain, and pt was admitted to on . again, she was ruled out for mi by ekg and cardiac enzymes. persantine stress test, which did not reproduce her pain, showed mostly fixed anterior infarct with mild lateral peri-infarct edema, no ischemia. she was d/c'd to rehab with a diagnosis of non-cardiac chest pain likely d/t gerd. . about one week later, on , she experienced similar symptoms, partially relieved by sl nitro. she went to her scheduled follow up appointments with dr. and dr. (gi), and during it she was found to have a her hct=26, and troponin=0.62 with equivocal ekg changes. she was admitted to for transfusion, but after 1 unit of prbcs, she developed acute congestive heart failure. she was diuresed with lasix 80 iv, given nitro paste, and, after these treatments, became hypotensive to 79/33. dopamine was started. cardiac enzymes revealed trop 2.96 and ck 170 (mb not done). decision was made to transfer patient to for further management/ catherization. of note, her wbc also increased to 15.2, and started on empiric levaquin. . on arrival to , pt admitted to ccu team. , pt was without complaints. she was taken to cath lab, where a near total occlusion of proximal/ostial lad was found along with a lcx 90% lesion (lcx dominant vessel). the lcx lesion was approached first. while intervening on the lcx lesion, the patient became hypotensive--likely from occluding the dominant lcx, causing decreased flow to lad. with the hypotension, she also became nauseous and vomitted (?aspirated). she then became asystolic. cpr was initiated as the procedure continued. the lad lesion was stented with good resultant flow and the lcx lesion was angioplastied (with resultant dissection). during this, the patient was intubated and started on levophed and dopamine. she went into a wide complex tachycardia--vt vs. svt/sinus tach w/ incomplete rbbb. she was started on lidocaine gtt and given 300mg amio bolus. at the time of transfer to the ccu, the patient's abg was 7.04/36/436 and lactate 6. . on arrival to the ccu, the patient was still vented. her blood pressure dropped into the 50s shortly after her arrival. after getting 2amps of bicarb, bp improved to sbp 90-100s. a-line placement was attempted unsuccessfully (with doppler in b/l radial vessels). a right femoral venous catheter was placed. of note, pt had bloody ngt drainage. . *** cardiac review of systems is notable for current absence of dyspnea on exertion, ankle edema, syncope or presyncope. (prior to cath) past medical history: htn, hyperlipidemia gerd cad - nstemi ; p-mibi w/ fixed anterior defect chf mild aymptomatic, noncritical carotid stenosis mild aortic stenosis h/o colon cancer, s/p colon resection iron deficiency anemia chronic low-grade gi bleed secondary to angiodysplasia of small bowel ? copd s/p cholecystectomy, appendectomy social history: patient had been living independently and doing her own adls until her mi in . since her mi, she has been in rehab. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: day of discharge vs: t 97, bp 119-152/39-55, hr 57-81, rr 18-20, 98 o2 % 1l gen: thin, in nad, resp or otherwise. oriented x3. mood, affect appropriate. pleasant. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with no appreciable jvd. cv: rrr normal s1/s2, iii/vi sem heard best at lusb, no rubs or gallops chest: kyphosis, barrel chest. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: soft, + bruising, ntnd, no hsm or tenderness. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 1+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 1+ dp pertinent results: 07:38pm blood wbc-13.6*# rbc-2.80* hgb-8.4* hct-27.1*# mcv-97# mch-30.0 mchc-31.0 rdw-16.3* plt ct-453* 06:30pm blood glucose-589* urean-28* creat-1.2* na-125* k-3.2* cl-100 hco3-8* angap-20 07:38pm blood calcium-7.7* phos-4.8* mg-1.4* 07:38pm blood pt-18.3* ptt-150* inr(pt)-1.7* 07:20am blood wbc-14.9* rbc-3.69* hgb-11.1* hct-34.4* mcv-93 mch-30.0 mchc-32.2 rdw-18.8* plt ct-486* 07:20am blood glucose-106* urean-26* creat-1.2* na-142 k-3.8 cl-102 hco3-29 angap-15 07:45am blood calcium-9.1 phos-3.6 mg-1.7 . 07:38pm blood ck(cpk)-153* 03:48am blood ck(cpk)-353* 04:51am blood ck(cpk)-219* 07:38pm blood ck-mb-14* mb indx-9.2* 03:48am blood ck-mb-28* mb indx-7.9* ctropnt-2.31* 04:51am blood ck-mb-8 ctropnt-1.88* . 06:55am blood probnp-* . 03:48am blood alt-390* ast-407* ld(ldh)-509* ck(cpk)-353* alkphos-122* amylase-208* totbili-0.3 06:45am blood alt-38 ast-24 alkphos-85 totbili-0.3 . echocardiogram the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with hypokinesis of the mid inferolateral wall and distal inferio wall. the remaining segments contract normally (lvef = 55 %). the estimated cardiac index is normal (>=2.5l/min/m2). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is mild-moderate aortic valve stenosis (area 1.2cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. there is at least mild pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. impression: normal left ventricular cavity size with mild regional systolic dysfunction suggestive of cad. mild-moderate aortic valve stenosis. at least mild pulmonary artery systolic hypertension. brief hospital course: year old woman with h/o cad, s/p anterior mi , resulting in depressed ef (35%) and anemia angiodysplagia-related gi bleed who was transferred from hosp for cardiac catherization and is s/p lcx stent with dissection leading to cardiac arrest requiring resuscitation and intubation. clinical status gradually improved but course complicated by multiple episodes of acute on chronic congestive heart failure (although present ef wnl), stable at discharge on diuretics. . 1.) cad/ischemia: s/p cardiac cath, which showed dominant lcx with 90% lesion & ostial lad lesion. the lad lesion was stented and the lcx lesion was angioplastied. this was complicated by dissection of lcx, with subsequent cardiac arrest in cath lab that resolved with cpr and pressors. the patient was medically managed with asa, plavix, statin, and metoprolol. she would benefit from starting an ace i once her creatinine has stabilized. . 2.) dysrrhythmia: pt went into wide-complex tacycardia (vt vs. svt/sinus tach with partial rbbb) after her cardiac arrest, converting to nsr on lidocaine drip & amiodarone. pt subsequently developed a fib with rvr in the 130s, which resulted in a hypotensive episode requiring cardioversion x 7 before stabilizing. throughout the rest of her hospital course, patient remained in normal sinus rhythm. the amiodarone and digoxin was discontinued prior to discharge as the afib only occurred in the setting of recent mi/cardiac arrest. . 3.) acute on chronic systolic heart failure: prior echo showed an ef of 35%, improved to 55% on echo. during her hospital course, pt had multiple episodes of acute respiratory distress secondary to the development of pulmonary edema in the setting of hypertension, likely due to a stiff lv. she was acutely managed with lasix, morphine, nitropaste and nebs prn with good response. she received afterload reduction with hydralazine. she also received a short course of prednisone in light of her copd. cxr on showed improvement in mild pulmonary edema with bilateral pleural effusions present which partially layer and occupy the fissure. pt stable on discharge dose of lasix 40 mg po daily, to be sent to rehab with o2 for dyspnea on exertion. . 4.) r/o infection: differential dx of acute respiratory distress included pneumonia. cxr with poor inspiratory effort and thus was difficult to interpret. endotracheal tube culture was mrsa +, and vancomycin was started empirically in the setting of acute respiratory distress although pt was afebrile with nl wbc. however, cxr was consistent with mod pulm edema with no opacities suggestive of pna, so vancomycin was discontinued. since then, patient has been afebrile, although wbc increased to peak of 17.3 but trending down at 14.3 on discharge in context of recent prednisone course. low suspicion for active infection as pt continued to be afebrile without cough/sputum, ua neg, ucx with normal flora, c. diff neg. . 5.) delirium: pt experience several episodes of delirium (sundowning) in the setting of complicated hospital course in intensive care unit. she responded well to haldol. since her transfer to the floor, her mental status is much improved without further incidences. . 6.) acute renal failure: pt with baseline cr of 1.2. on discharge, creatinine is stabilizing at 1.2, down from a creatinine max of 1.7. we suspected this was due to contrast nephropathy, shock, or possibly prerenal volume depletion. . 7.) anemia: pt has h/o anemia due to chronic gi bleeding related to angiodysplasia of small bowel, s/p 1 unit prbc transfusion at osh on . she had bloody ngt drainage post-cath. on she had clear bloody fluid per rectum. she had a guiac + black stool on and subsequently. however, she had a normal colonoscopy within the past year. in addition, hct was stable (ranging from 31 to 35) and in light of her complicated hospital course, it was determined by the attending and with family that further intervention with endoscopy would not offer any therapeutic benefit. she will continue enteric-coated asa 81mg po daily and plavix 75 mg po daily for her stent. she is on lansoprazole 30 daily. . 8.) elevated lfts were noted post-hypotension. we suspected this was secondary to shock liver as they normalized when re-checked on . . 9.) fen/gi: speech and swallow evaluated the patient several times post-extubation and in her most recent eval they did not find clinical evidence of aspiration and she was advanced to liquids and soft solids. clinical nutrition saw the patient on and recommended that she be on a low salt diet with supplemental high calorie, high protein shakes. she should have regular calorie intake monitoring to ensure adequate nutrional support. medications on admission: advair diskus 150 mcg 1 puff b.i.d. spiriva 1 capsule inhaled daily aldactone 25 mg p.o. daily avapro 75 mg p.o. daily crestor 10 mg p.o. daily desyrel 50 p.o. at bedtime iron sulfate 325 mg a day lasix 20 mg monday, wednesday, and friday plavix 75 mg a day pletal 50 mg a day protonix 40 mg b.i.d. tenormin 25 mg zetia 10 mg a day carafate 1 g liquid four times daily. discharge medications: 1. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 2. rosuvastatin 5 mg tablet : two (2) tablet po daily (daily). 3. fluticasone-salmeterol 250-50 mcg/dose disk with device : one (1) disk with device inhalation (2 times a day). 4. tiotropium bromide 18 mcg capsule, w/inhalation device : one (1) cap inhalation daily (daily). 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 6. hydralazine 10 mg tablet : two (2) tablet po q6h (every 6 hours). 7. metoprolol tartrate 50 mg tablet : one (1) tablet po bid (2 times a day). 8. aspirin ec 81 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po once a day. 9. trazodone 50 mg tablet : 0.5 tablet po hs (at bedtime) as needed. 10. furosemide 40 mg tablet : one (1) tablet po daily (daily). 11. aspirin 81 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po daily (daily). 12. prevacid solutab 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr once a day. 13. colace 100 mg capsule : one (1) capsule po twice a day. 14. sodium chloride 0.65 % aerosol, spray : sprays nasal qid (4 times a day) as needed. 15. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for fever or pain. 16. ferrous sulfate 325 mg (65 mg iron) tablet : one (1) tablet po once a day. 17. senna 8.6 mg tablet : one (1) tablet po twice a day as needed for constipation. discharge disposition: extended care facility: - discharge diagnosis: primary: coronary artery disease s/p stenting ventricular fibrillation s/p cardioversion aspiration pneumonia copd exacerbation . secondary: hypertension mental status changes chronic kidney failure discharge condition: stable. ambulating with minimal supplemental oxygen with 1 person assist for transfers. discharge instructions: you were admitted for cardiac cath and underwent stenting of your coronary arteries. however, the procedure was complicated by a ventricular arrhythmia that required cardioversion. you were intubated emergently and transferred to the cardiac intensive care unit. your heart muscle appears to have preserved function and you will follow up with your cardiologist for a follow up echo in weeks. . we have made some changes to your medications as seen below: we have discontinued your aldactone, avapro, pletal, protonix, zetia, carafate, atenolol. we have changed your lasix to 40mg by mouth daily and trazodone to 25mg po qhs. we have added the following medications: hydralazine 10mg, two tabs by mouth every 6 hours. metoprolol 50mg by mouth twice a day. asa 81mg po daily lansoprazole 30mg po daily. . if you develop any new chest pain, shortness of breath or any other general worsening of condition, please call your pcp or come directly to the ed. followup instructions: dr. follow up appointment on tuesday at 2pm dr. follow up appointment wednesday at 10am procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization insertion of endotracheal tube enteral infusion of concentrated nutritional substances other electric countershock of heart insertion of temporary transvenous pacemaker system cardiopulmonary resuscitation, not otherwise specified insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: other primary cardiomyopathies coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute and subacute necrosis of liver acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) cardiac complications, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation accidental puncture or laceration during a procedure, not elsewhere classified acute respiratory failure pneumonitis due to inhalation of food or vomitus cardiac arrest acute on chronic systolic heart failure subendocardial infarction, subsequent episode of care delirium due to conditions classified elsewhere angiodysplasia of stomach and duodenum with hemorrhage dissection of coronary artery acute coronary occlusion without myocardial infarction 

Answer: The patient is high likely exposed to