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: chest pain major surgical or invasive procedure: cardiac catherization with emergent ecmo placement removal ecmo cannula with right cfa open repair emergent bivad placement, cabg x2 (svg>lad, svg>om) re exploration for bleeding quintin catheter history of present illness: 42 yo male with a hx of dmii, poorly controlled htn and fh of cad who presents with chest pain. pt reports intermittent exertional chest pain over the past 2-3 months which he describes as sharp, l sided sscp radiating to l arm, pain lasts 5-7 minutes and is relieved with rest. pain is at its worst and has associated sob, diaphoresis and nausea but no emesis. he presented to new pcp today whom noted elevated bp 190/100 and sent to ed for further evaluation given exertional cp and strong fam hx of cad. pt occasionally takes his meds and does not go to doctor , he was not formally dx with dm, his fs at home have been in 200s on no treatment for dm. past medical history: htn dmii obesity social history: social history is significant tobacco - quit 4 months ago he smoked 1pack per week. denies etoh family history: there is premature coronary artery disease, father-died of mi at age 57, brother mi at 48, sister mi s/p cabg at age 38. mother-htn, dm physical exam: admission vs: t 100.0, bp 143/70, hr 62, rr 16, o2 99% on 2l gen: middle aged male 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 jvp of 7cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3. no m/r/g chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: non pitting ankle edema. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp pertinent results: 01:46am blood wbc-16.2*# rbc-4.14* hgb-12.9* hct-34.6* mcv-84 mch-31.1 mchc-37.3* rdw-15.9* plt ct-69* 04:10pm blood wbc-11.2* rbc-5.00 hgb-13.3* hct-37.9* mcv-76* mch-26.7* mchc-35.2* rdw-14.8 plt ct-383 09:29pm blood neuts-89.5* bands-0 lymphs-8.6* monos-1.5* eos-0.3 baso-0.1 04:10pm blood neuts-77.8* lymphs-15.0* monos-2.9 eos-3.9 baso-0.4 12:49pm blood plt ct-74* 12:49pm blood pt-14.3* ptt-45.2* inr(pt)-1.3* 04:10pm blood plt ct-383 04:10pm blood pt-12.3 ptt-26.1 inr(pt)-1.1 08:04am blood fibrino-128* 08:21pm blood fibrino-174 01:46am blood glucose-132* urean-26* creat-3.3* na-139 k-4.9 cl-104 hco3-21* angap-19 04:10pm blood glucose-118* urean-11 creat-1.0 na-140 k-4.1 cl-105 hco3-26 angap-13 02:59am blood alt-114* ast-763* ld(ldh)-1827* alkphos-43 totbili-1.7* 03:20pm blood alt-12 ast-12 alkphos-74 totbili-0.5 02:59am blood albumin-2.6* 01:46am blood calcium-8.7 phos-6.2*# mg-2.1 04:10pm blood triglyc-250* hdl-40 chol/hd-8.5 ldlcalc-249* 06:13am blood vanco-31.7* 03:57pm blood type-art po2-113* pco2-42 ph-7.36 caltco2-25 base xs--1 03:49pm blood type-art po2-262* pco2-68* ph-6.88* caltco2-14* base xs--22 -assist/con intubat-intubated 04:23pm blood type-art po2-330* pco2-55* ph-7.16* caltco2-21 base xs--9 intubat-intubated vent-controlled 05:15pm blood type-art po2-416* pco2-38 ph-7.40 caltco2-24 base xs-0 01:23pm blood glucose-134* lactate-2.3* k-5.2 08:41pm blood glucose-188* lactate-10.8* na-142 k-4.0 cl-103 04:23pm blood glucose-375* lactate-13.6* na-139 k-2.9* cl-105 radiology final report ct head w/o contrast 10:20 am ct head w/o contrast reason: r/o cva medical condition: 42 year old man cardiac arrest w/vad placement reason for this examination: r/o cva contraindications for iv contrast: none. indication: 42-year-old man status post cardiac arrest with vad placement, rule out stroke. comparisons: none. technique: axial mdct images were performed through the brain without iv contrast. findings: there is a large evolving right pca distribution infarction, with significant mass effect, effacing the right ambiant cistern and effacing the right lateral ventricle. there is no herniation at this time and no hydrocephalus in the contralateral ventricular system. no evidence of hemorrhagic transformation or acute hemorrhage elsewhere in the brain. tiny hypodensities involving the anterior aspects of the centrum semiovale bilaterally likely relate to small infarcts, acuity indeterminate. globally, the sulci appear slightly effaced, however, this may be a normal variant, however, given the history provided, diffuse global edema is also a consideration. -white matter differentiation remains preserved at this time. there is an air-fluid level in the left maxillary sinus and a smaller air-fluid level in the left sphenoid sinus presumably from prior intubation. impression: 1) large evolving right pca distribution infarction, with significant local mass effect, effacing the right lateral ventricle and right ambient cistern, without ct evidence of herniation at this time. no evidence of hemorrhagic transformation or acute intracranial hemorrhage elsewhere in the brain. 2) two small hypodensities in the anterior aspect of the centrum semiovale bilaterally, likely representing small infarcts, age indeterminate. 3) the sulci appear somewhat effaced globally; this could be a normal variant, however, given the history of cardiac arrest, global edema must be considered. findings were discussed with the covering nurse practitioner () at the ct scanner at the time of the study. the study and the report were reviewed by the staff radiologist. dr. dr. approved: 4:49 pm radiology final report chest (portable ap) 1:02 am chest (portable ap) reason: s/p tlc insertion and ett reposition-check placement medical condition: 42 year old man with lm dissection s/p emergent -vad placement/cabg x 2. please at with abnormalities. reason for this examination: s/p tlc insertion and ett reposition-check placement portable supine chest 1:22 a.m. indication: recently status post emergent cardiac surgery. recent ett repositioning and central line placement. findings: compared with the previous study at 11:33 p.m. on , the tip of the ett has been repositioned and now lies approximately 2 cm above the carina. the tip of the new left cvl projects at the upper svc level. otherwise, no obvious interval changes, as detailed in previous report. dr. approved: 12:35 pm radiology final report chest (portable ap) 1:02 am chest (portable ap) reason: s/p tlc insertion and ett reposition-check placement medical condition: 42 year old man with lm dissection s/p emergent -vad placement/cabg x 2. please at with abnormalities. reason for this examination: s/p tlc insertion and ett reposition-check placement portable supine chest 1:22 a.m. indication: recently status post emergent cardiac surgery. recent ett repositioning and central line placement. findings: compared with the previous study at 11:33 p.m. on , the tip of the ett has been repositioned and now lies approximately 2 cm above the carina. the tip of the new left cvl projects at the upper svc level. otherwise, no obvious interval changes, as detailed in previous report. dr. approved: 12:35 pm cardiology report ecg study date of 7:39:30 am sinus rhythm. compared to the previous tracing sinus tachycardia has given way to normal sinus rhythm, rate 80, and ischemic type lateral repolarization changes have resolved. tracing #2 read by: , s. intervals axes rate pr qrs qt/qtc p qrs t 80 130 74 348/383.71 18 4 22 cardiology report echo study date of *** report not finalized *** preliminary report patient/test information: indication: intra-op tee for emergent cabg, lvad palcement, pt placed emergently on ecmo in cath lab height: (in) 68 weight (lb): 244 bsa (m2): 2.23 m2 status: inpatient date/time: at 17:42 test: tee (complete) doppler: full doppler and color doppler contrast: none tape number: 2007aw209-9:4 test location: anesthesia west or cardiac technical quality: adequate referring doctor: dr. r. measurements: left atrium - long axis dimension: *6.1 cm (nl <= 4.0 cm) left atrium - four chamber length: 4.9 cm (nl <= 5.2 cm) left ventricle - septal wall thickness: 1.0 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: 1.0 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 5.6 cm (nl <= 5.6 cm) aorta - valve level: 2.6 cm (nl <= 3.6 cm) aorta - ascending: 2.3 cm (nl <= 3.4 cm) aorta - descending thoracic: 2.1 cm (nl <= 2.5 cm) interpretation: findings: pt was placed on emergent ecmo in the cath lab. rhythm was v. fib initially. left atrium: marked la enlargement. right atrium/interatrial septum: normal ra size. no asd by 2d or color doppler. left ventricle: depressed lvef. right ventricle: rv function depressed. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. normal aortic arch diameter. normal descending aorta diameter. aortic valve: significant ar, but cannot be quantified. mitral valve: mr present but cannot be quantified. tricuspid valve: tr present - cannot be quantified. pulmonic valve/pulmonary artery: physiologic (normal) pr. pericardium: trivial/physiologic pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. no tee related complications. the patient was under general anesthesia throughout the for the patient. see conclusions for post-bypass data the post-bypass study was performed while the patient was receiving vasoactive infusions (see conclusions for listing of medications). conclusions: post-ecmo: 1. the left atrium is markedly dilated. no atrial septal defect is seen by 2d or color doppler. 2. lv systolic function appears depressed. the entire lv lateral, inferior & anterior wall appear akinetic. lv appears distended. 3. right ventricular systolic function appears depressed. 4. significant aortic regurgitation is present, but cannot be quantified given that pt is on ecmo. 5. mitral regurgitation is present but cannot be quantified. 6. tricuspid regurgitation is present but cannot be quantified. 7. there is a trivial/physiologic pericardial effusion. post- bivad: 1. bivad cannulas are seen in position. the heart is decompressed. physician: cardiology report c.cath study date of *** not signed out *** brief history: **ptca results lmca **baseline stenosis pre-ptca **technique ptca sequence 1 guiding cath 6f xblad guidewires choice p initial balloon (mm) 2.5 final balloon (mm) 2.5 # inflations 2 max pressure (psi) 180 ptca comments: during diagnostic angiography, the left main was noted to either have a dissection or a severe ulcer. the plan was to put an iabp and send him to surgery emergently as he was stable. over the course of 5 minutes while placing the iabp, the patient developed chest pain. the iabp was placed urgently and access in the l cfa was obtained. given the chest pain, the plan was made to emergently repair the lmca. suddenly the patient became apneic and pulseless. cpr was initiated. a 6f xblad3.5 guiding catheter was used to engage the lmca and no flow was noted. a choice pt wire was passed into the cx. a 2.5x15 mm voyager balloon was used to dilate the lmca at 10 atm and flow was restored to the cx and om. the patient was intubated and cpr was continued thru this intervention. ct surgery was consulted and were immediately there to evaluate the situation. decision was made to convert from iabp support to ecmo and transfer the patient emergently to cabg and or lvad. the patient went into ventricular fibrillation and was shocked at 360 j, just before ecmo cannulas were placed in the r cfa and cfv. flows were achieved of 4l/min and the patient was transferred to the or for bypass. comments: 1) 2) emergent ptca of the dissected lmca with a 2.5 mm balloon with flow restoration into the cx and om. iabp support initiated and converted to ecmo support as the patient clinically and hemodynamically deteriated. cpr and intubation required during case. patient was transferred emergently to the or for cabg and or lvad. final diagnosis: 1. three vessel coronary artery disease. 2. emergent ptca with iabp support for a lmca dissection. 3. ecmo initiated due to severe cardiogenic shock. 4. cpr and intubation for cardiac arrest. 5. transfered to or for emergent cabg and or lvad. attending physician: , s. referring physician: , . cardiology fellow: , , attending staff: , s. brief hospital course: 42 year old male presented to pcp with transferred to ed with chest pain. admitted for cardiac work up and underwent cardiac catherization . in catherization lab had cardiac arrest secondary to left main dissection and ecmo was inserted. he went directly to the operating room where he had a biventricular assist device placed, coronary artery bypass graft, removal of ecmo, and repair right cfa. please see operative report for details of operation. postoperatively, he was taken to the csru in critical condition with his chest left open. he continued to bleed, and was re-explored at the bedside the night of surgery. he returned to the or the following day again for re-exploration for bleeding. the bleeding has since subsided. he was weaned from vasoactive drips, and has remained hemodynamically stable on the bivad's, with flows in the 4.5 liter per minute range. on pod # 1, the patient had progressed into renal failure, and cvvh was initiated. a ct scan of his brain was obtained to r/o significant infarct or bleed. this revealed a right pca infarct. the neurology service was consulted, and it was their belief that the patient would be left with a left visual field deficit, did not expect pt. to have permanent disability. he is being transferred to for continued treatment, and possible transplant evaluation. medications on admission: capoten 50mg daily asa 81mg daily discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. fentanyl citrate (pf) 0.05 mg/ml solution sig: one hundred (100) mcg/hr injection infusion (continuous infusion). 4. artificial tear with lanolin 0.1-0.1 % ointment sig: one (1) appl ophthalmic every eight (8) hours. 5. albuterol 90 mcg/actuation aerosol sig: four (4) puff inhalation q4h (every 4 hours). 6. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 7. insulin regular human 100 unit/ml solution sig: three (3) units/hr injection infusion (continuous infusion). 8. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: 1300 (1300) units/hr intravenous infusion . 9. midazolam 5 mg/ml solution sig: 0.5 mg/hr injection infusion (continuous infusion). 10. beclomethasone dipropionate 80 mcg/actuation aerosol sig: two (2) puffs inhalation (). 11. cisatracurium besylate 0.06-0.30 mg/kg/hr iv titrate to 0 of 4 train of 4 patient should be ventilated and sedated prior to initiating nmbas. 12. pantoprazole 40 mg iv q24h 13. vancomycin 1000 mg iv q 24h please check level in am before dosing 14. metronidazole (flagyl) 500 mg iv q8h discharge disposition: extended care discharge diagnosis: biventricular failure s/p bivad cad s/p dissection s/p cabg respiratory failure renal failure hypertension diabetes mellitus obesity discharge condition: guarded discharge instructions: transfer to for continued evaluation followup instructions: transfer to procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified coronary arteriography using two catheters (aorto)coronary bypass of two coronary arteries left heart cardiac catheterization diagnostic ultrasound of heart fiber-optic bronchoscopy hemodialysis venous catheterization for renal dialysis implant of pulsation balloon transfusion of packed cells cardiopulmonary resuscitation, not otherwise specified transfusion of other serum other operations on vessels of heart transfusion of platelets implant of single ventricular (extracorporeal) external heart assist system transfusion of coagulation factors extracorporeal membrane oxygenation [ecmo] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hemorrhage complicating a procedure cardiac arrest cardiogenic shock obesity, unspecified cerebral embolism with cerebral infarction acute myocardial infarction of unspecified site, initial episode of care other and unspecified coagulation defects iatrogenic cerebrovascular infarction or hemorrhage dissection of coronary artery 

Answer: The patient is high likely exposed to