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: no known allergies / adverse drug reactions attending: chief complaint: dyspnea on exertion epigastric pain major surgical or invasive procedure: none history of present illness: pt is a 69 year-old male with dchf (ef>60% ), iddm2, htn, and cad s/p muliple stents with multiple isrs, and recent pe () recently admitted to from for cp and dyspnea at rest who underwent c. cath which showed 3vd, diffuse lad disease, and severe isrs of rca without intervention. he has had intermittent cp and doe 1-2 times per week since discharge with improvement from sl nitro. the last 2-3 days he has had increasing epigastric/cp and doe with decreased response to sl ntg. he saw his pcp () who sent him to the ed. . ed course: initial vitals: pain 7, t: 97.1, hr: 81, bp: 117/63, rr: 16, po2: 99% 2lnc. ekg per report with st elevations in ii/iii/avf whic were present on previous ekgs but may have been minimally increased and new twi in v2, i, avl. stools heme negative, given 325mg asa, plavix 600mg, started on heparin drip with bolus of 4,000 @ 900u/hr, started on ntg drip at 0.14 mcg/kg/min. 18g x2 piv in place. vitals on transfer: 73, 149/68, 15, 100%/1l. cp free in the , unclear what resolved it. on transfer noted that he has a ha and wants to eat and go home. . on review of systems, he does report prior pe which he was treated with coumadin for 6 months. he denies any prior history of stroke, tia, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. all of the other review of systems were negative. . cardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: (+)diabetes,(+)dyslipidemia,(+)hypertension 2. cardiac history: dchf ef 55% on echo, on echo had ef 55% and signs of acute r heart strain due to pe -percutaneous coronary interventions: cad s/p multiple pcis - - anatomy unknown -: successful poba and direct bare metal stenting of the rca -: one vessel coronary artery disease (known 2 vessel cad with lca not injected). ptca of the instent occlusion of the distal rca. -: poba of the rca and successful stenting of the ramus. -: stenting of the distal avg lcx. stenting of the om2-3 origin disease. stenting of the proximal ri disease. all were des -: ptca and stenting of the avg lcx (with a 2.5x15 mm xience des) and proximal ri (with 3.0x16 mm taxus des). -: 50-60% mid lad, 80% distal lad; 90% stent restenosis at origin om1; 40-50% distally; 90% restenosis of om2. poba with cutting and kissing balloon. 3. other past medical history: * hypertension * diabetes mellitus type 2 on insulin: last a1c: 6.8 on . * hyperlipidemia: ldl 86, hdl 30, tg 235, chol 163 on . * hypothyroidism: tsh 0.47 * gerd * nash * s/p appy * acousting neuroma * erectile dysfunction - s/p prosthesis social history: originally from , spanish speaking, married. currently retired. he has never smoked. no etoh, though drank in the past heavily and quit 2 years ago. he denies any illegal substance use. he lives at home with wife, son, and granddaughter and is mobile with a cane. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. father died of an mi age 83; mother died of mi age 78. physical exam: admission exam: general: nad. spanish speaking only. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple jvp not appreciated cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . discharge exam: vitals - tm/tc:98.3/98.3 hr:61-73 bp:111-134/58-69 rr:18 02 sat: 99% ra in/out: last 24h: last 8h: 475/200 weight: 77(78) . general: 69 yo m in no acute distress heent: mucous membs moist, no lymphadenopathy, jvp non elevated sitting up chest: ctabl no wheezes, no rales, no rhonchi cv: s1 s2 normal in quality and intensity rrr no murmurs rubs or gallops abd: soft, non-tender, obese, bs normoactive. ext: wwp, no edema. dps, pts 2+. neuro: cns ii-xii intact. 5/5 strength in u/l extremities. gait steady. skin: no rash psych: a/o cooperative and pleasant . pertinent results: admission labs: 04:50pm glucose-122* urea n-16 creat-1.1 sodium-138 potassium-4.7 chloride-106 total co2-20* anion gap-17 04:50pm calcium-9.5 phosphate-3.1 magnesium-1.7 04:50pm wbc-4.8 rbc-4.21* hgb-10.5* hct-31.5* mcv-75* mch-25.0* mchc-33.4 rdw-17.0* . pertinent labs: 04:50pm ctropnt-<0.01 11:21pm ck-mb-4 ctropnt-<0.01 06:21am blood ck-mb-3 ctropnt-<0.01 06:21am blood triglyc-280* hdl-30 chol/hd-5.0 ldlcalc-63 . discharge labs: 07:07am blood wbc-3.7* rbc-3.93* hgb-9.7* hct-30.4* mcv-78* mch-24.8* mchc-32.0 rdw-16.6* plt ct-182 07:07am blood glucose-169* urean-9 creat-0.9 na-139 k-4.1 cl-107 hco3-26 angap-10 07:07am blood calcium-9.0 phos-3.5 mg-2.1 . stress impression: anginal type symptoms in the presence of non-specific ekg changes during recovery at a low cardiac demand and fair functional capacity. blunted hemodynamic response. echo report sent separately. . echo: the patient exercised for 10 minutes and 30 seconds according to treadmill protocol (5.5 mets) reaching a peak heart rate of 105 bpm and a peak blood pressure of 118/48 mmhg. the test was stopped because of fatigue. the test was stopped because of shortness of breath. this level of exercise represents a fair exercise tolerance for age. in response to stress, the ecg showed equivocal/borderline ischemic st wave changes (see exercise report for details). the blood pressure response to stress was blunted. there was a normal heart rate response to exercise. . resting images were acquired at a heart rate of 72 bpm and a blood pressure of 108/54 mmhg. these demonstrated normal regional and global left ventricular systolic function. right ventricular free wall motion is normal. there is no pericardial effusion. doppler demonstrated no aortic stenosis, aortic regurgitation or significant mitral regurgitation or resting lvot gradient. echo images were acquired within 86 seconds after peak stress at heart rates of 98 - 90 bpm. these demonstrated appropriate augmentation of all left ventricular segments with slight decrease in cavity size. there was augmentation of right ventricular free wall motion. . impression: fair functional exercise capacity. borderline ecg changes in the absence of 2d echocardiographic evidence of inducible ischemia to achieved workload. . cardiac cath 1. selective coronary angiography in this right dominant system demonstrated three vessel disease. the lmca had no angiographically apparent disease. the lad had a 50% mid vessel stenosis aswell as a 60% distal stenosis. the cx had a 40-50% proximal stenosis with patent stents. the rca was diffusely diseased with serial 90% stenoses. 2. limited resting hemodynamics revealed mildly elevated left sided filling pressures and normal right sided filling pressures with an lvedp of 16 mmhg and an rvedp of 11 mmhg. there was moderate systolic pa hyertension with a pasp of 40mmhg but a normal mean pa pressure of 21 mmhg. the central aortic pressure was 118 /49 mmhg. there was no transvalvular gradient on pullback form the lv to the aorta. the cardiac index was preserved at 2/9 l/min/m2. 3. successful ptca of the distal to proximal rca with a 2.0x12 apex balloon. final angiography revealed 30% residual mid vessel stenosis, but no angiographically apparent dissection and timi iii flow (see ptca comments). 4. successful stenting on the proximal rca with a 2.5x15mm promus stent which was deployed at 12 atms. final angiography revealed no residual stenosis, no angiographically apparent dissection and timi iii flow (see ptca comments). final diagnosis: 1. three vessel coronary artery disease. 2. successful stenting of the proximal rca with a des. 3. successful poba of the distal to proximal rca. brief hospital course: assessment and plan: 69 year-old male with dchf, dm2, htn, and cad s/p muliple stents with multiple in-stent restenoses, and recent pe () here with epigastric pain and doe. . active issues: # cad: dyspnea on exertion possibly multifactorial but likely preedominantly anginal equivalent given his diffuse cad. this was initially managed by increasing his anti-anginal medications however the patients symptoms did not improve. he then underwent cardiac cath and des of proximal rca as well as angioplasty of the distal to proximal rca with improvement of his symptoms. because of concern that his antianginal medications were leading to fatigue his metoprol and imdur were decreased. he was also started on diltiazem. . # epigastric pain/gerd: initially his epigastric pain was thought o be realted to his cad. however, it was later identified that his epigastric pain occured only aftert meals and with meds and did not occur with exertion and was not associateed with his doe. he believed this was worsened by increased doses of imdur so this was decreased. he was instructed to continune his h2 blocker and take a ppi daily but to avoid omeprazole as this may interfere with plavix. . chronic issues: # pe: unprovoked saddle pe in requiring tpa. previously on coumadin but stopped after 6 months. has had normal psa and colonoscopy in . would consider further outpatient coagulation workup. . # diastolic chf: clinically euvolemic. continued home medications . # htn: hypertension medications adjusted as described above. well controlled on discharge. . # hld: continue atorvastatin 80mg. . # dm2: continued home medications. . # hypothyroidism: cont levothyroxine 100mg daily . transitional issues: #plavix: pt received a des during his cath and should be on plavix for at least one year from that date. . #hypercoagulability work up: patient had an unprovoked pe and would likely benefit from further work up of possible hypercoagulability and malignancy. medications on admission: home medications: confirmed with patient 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily 2. levothyroxine 100 mcg tablet sig: one (1) tablet po daily 3. ranitidine hcl 150 mg tablet sig: two (2) tablet po bid 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily 6. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal daily 7. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 9. metoprolol succinate 200 mg tablet extended release 24 hr sig: 1.25 tablet extended release 24 hrs po once a day. 10. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) sublingual every six (6) hours as needed for chest pain: take up to 3 seperated by 5 minutes each. call your doctor if pain is not resolved. 11. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 12. metformin 850 mg tablet sig: one (1) tablet po twice a day. 13. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: two (2) tablet extended release 24 hr po daily (daily). disp:*60 tablet extended release 24 hr(s)* refills:*2* 14. valsartan 80 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 15. insulin nph & regular human 100 unit/ml (70-30) suspension sig: fifty three (53) units subcutaneous in the morning. 16. insulin nph & regular human 100 unit/ml (70-30) suspension sig: sixty three (63) units subcutaneous in the evening. 17. insulin lispro 100 unit/ml solution sig: five (5) units subcutaneous before afternoon meal. 18. esomeprazole magnesium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 3. ranitidine hcl 150 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal daily (daily). 7. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for sleep. 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 9. metoprolol succinate 100 mg tablet extended release 24 hr sig: two (2) tablet extended release 24 hr po daily (daily). 10. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet sublingual as directed as needed for chest pain. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 12. metformin 850 mg tablet sig: one (1) tablet po twice a day. 13. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). disp:*30 tablet extended release 24 hr(s)* refills:*2* 14. valsartan 80 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 15. insulin nph & regular human 100 unit/ml (70-30) suspension sig: fifty three (53) units subcutaneous once a day. 16. insulin nph & regular human 100 unit/ml (70-30) suspension sig: sixty three (63) units subcutaneous before dinner. 17. insulin lispro 100 unit/ml solution sig: five (5) units subcutaneous before afternoon meal. 18. esomeprazole magnesium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 19. diltiazem hcl 180 mg capsule, extended release sig: one (1) capsule, extended release po daily (daily). disp:*30 capsule, extended release(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: chest pain coronary artery disease gastroesophageal reflux disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you at . you were admitted with stomach pain and shortness of breath. we have adjusted your medicines and your shortness of breath. you did not have a heart attack. a stress test showed that your heart muscle could benefit from a stent. you underwent cardiac cathertization and a stent was placed in the right coronary artery. after stent placement your symptoms improved. you have a lot of stomach discomfort and heartburn, you are on 2 different medicines for this and we have decreased the imdur medicine that you feel makes the heartburn worse. you have had a scope in the past to look at your stomach, dr. may decide that you should have another one. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. . we made the following changes to your medicines: 1. decrease your isosorbide mononitrate to 30mg once daily 2. start diltiazem once daily to help improve the blood flow to your heart. 3. increase ranitidine to 300mg twice daily 4. deacrease metoprolol to 200 mg daily followup instructions: department: podiatry when: thursday at 9:25 am with: , dpm building: ba ( complex) campus: west best parking: garage department: cardiac services when: thursday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage name: , f. location: /east address: , e/cc-6, , phone: appt: the office is working on an appt for you and will call you at home with the appt. if you dont hear from them in the next 2 business days, please call directly to book. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor 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 single vessel diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux intermediate coronary syndrome congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism other and unspecified hyperlipidemia long-term (current) use of insulin cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other complications due to other cardiac device, implant, and graft chronic diastolic heart failure personal history of pulmonary embolism 

Answer: The patient is high likely exposed to