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: ace inhibitors attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catherterization (no interventions) history of present illness: patient is an 87 year old female with a history of of atrial fibrillation on coumadin, embolic stroke, and breast cancer, who presented from home to ed with substernal chest pain that awoke her from sleep at 4 am. the pain radiated to left arm and back. she had no nausea, vomiting, shortness of breath, or diaphoresis. her pain was initially and improved to with sub-lingual nitroglycerin in the er. . in the emergency room, her hr 60s, bp 180/73, rrr 15, 02 97% on 3l. initially, her ekg showed st 1-2mm elevations in v1-2 with scooped st segment depressions in ii, iii & avf. a code stemi activated. she was given asa, plavix 600, integrillin bolus, heparin bolus @ 4500. . in the catherization lab, patient found to have r dominant system w/ "hazy" 50% proximal lad eccentric occlusion, 30% mid lad, 40% proximal rca. decision was made to treat the proximal lad lesion medically. following the procedure, she continued to have some substernal chest and back pain. she was started on a nitro gtt. her pain improved. she was admitted to the icu for closer monitoring. shortly after arrival to icu, she underwent cta chest to evaluate for aortic dissection as well as pulmonary embolism. this was negative, showing only a previously seen iliac aneurysm with associated thrombus. her pain had completely resolved following the cta. . of note, her daughter reports that the patient's blood pressure has been elevated near systolic of 200s intermittently this past week. she was seen by her pcp for this, but when she was at the office her bp had normalized. . on review of systems, she denies any prior history of deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, cough, hemoptysis, black stools or red stools. she does note decreased exercise capacity due to difficulty walking pain in groin. her pcp is aware of this. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. *** cardiac review of systems is notable for dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: atrial fibrillation cva mild as uti sciatica large intestine benign villous adenoma htn breast cancer spinal stenosis retinal artery occlusion - left 15yr ago autonomic bladder dysfunction h/o orthostatic hypotension . cardiac risk factors: - diabetes, - dyslipidemia, + hypertension social history: widowed. lives alone in . daughter lives 40min away, visits once/week to help with household chores and food shopping. she is a non-smoker and does not abuse etoh. family history: no family history of premature coronary artery disease or sudden death. physical exam: at time of admission: vs - 96.3, 61, 165/62, 18, 98% on ra gen: pleasant, no acute distress heent: nc/at, eomi, non-icteric, mmm cv: s1, s2, ii/vi rusb murmur, w/o radiation pulm: cta bilaterally abd: soft, nontender, normoactive bowel sounds ext: no c/c/e pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: ekg serial: initial ed (637am): sinus 57, st elevations v1-2, st depressions in ii, iii, avf, v4-6. #2 (720am): near resolution of ste in v1 #3 (803am): stable #4 (519pm): ste fully resolved in v1-2, less st dep in inf leads (no intervention except anti-coag) . comments: 1. coronary angiography of this right dominant system revealed 2 vessel coronary artery disease. the lmca had no significant coronary disease. the proximal lad had a hazy appearing 50% eccentric stenosis with a 30% mid stenosis. the lcx had no significant coronary disease. the rca had a 40% proximal stenosis. 2. resting hemodynamics revealed severe systolic hypertension with an sbp of 193 mm hg initially. during the procedure, the patient's blood pressure exceeded 210 mm hg and a nitroglycerine iv drip was started. 3. left ventriculography was not performed. final diagnosis: 1. two vessel coronary artery disease. . chest x-ray: impression: no acute cardiopulmonary process . cta: cta: there are no filling defects within the pulmonary arteries to suggest pulmonary emboli. the pulmonary artery trunk measures 3.1 cm (3, 34) suggestive of pulmonary arterial hypertension. atherosclerotic plaque is noted in the thoracic and intra-abdominal portions of the aorta. there is no evidence of dissection. just inferior to the aortic bifurcation within the right iliac artery, there is aneurysmal dilatation measuring 2.4 x 2.4 cm (3, 161). extensive intraluminal thrombus is identified within this aneurysmal segment with areas of ulceration. right renal artery stenosis and celiac artery stenosis is noted. ct chest: there is no axillary, hilar or mediastinal lymphadenopathy. bibasilar atelectasis is noted in both lungs. there are no nodules or consolidations. there is no pericardial or pleural effusion identified. moderate cardiomegaly with calcifications of the valves and coronary arteries are noted. ct of the abdomen: the liver, gallbladder, spleen, pancreas, adrenal glands and kidneys are unremarkable. small bowel loops are normal in caliber and without focal wall thickening. there is no mesenteric or retroperitoneal lymphadenopathy. there is no free fluid or free air. bone windows: extensive degenerative changes of the spine are noted. there are no suspicious lytic or sclerotic lesions identified. impression: 1. no evidence of pulmonary embolism or aortic dissection. 2. atherosclerotic plaque of the intrathoracic and intra-abdominal aorta with aneurysmal dilatation seen of the right common iliac artery with extensive thrombus identified. 3. extensive calcifications of the mitral and aortic valves and coronary arteries. 4. cardiomegaly. . right groin ultrasound: impression: no evidence of , fistula, or hematoma brief hospital course: patient is an 87 year old woman with history of atrial fibrillation on coumadin, prior stroke, breast cancer, and hypertension who presents with presented with pain and acute st elevation concerning for myocardial infarction. . # chest pain/coronary artery disease: there was concern for an st elevation myocardial infarction given the patient's presentation and ekg findings. a code stemi was activated and patient was taken to the cardiac catherization lab. there was no significant flow limiting disease, and no interventions were made. patient's cardiac enzymes trended upward, with a peak ck of 313 and mb of 35. it was felt that the bump in her cardiac enzymes may have been secondary to a transient thrombus proximal to the lad, which may have resolved by the time the patient underwent catherization; this would also be consistent with her ekg changes which improved prior to catherization. decision was made to continue maximal medical management. her medication regimen included 325 mg aspirin, 80 mg of atorvastatin, and 25 mg of atenolol at time of discharge. she was initially maintained on a heparin drip for concern over acs, however this was stopped. blood pressure control was also aggressively targeted, as this also could have been contributing to her pain while she was acutely hypertensive; she was initially on a nitroglycerin drip, and then her oral medications were adjusted as needed. she initially had some bleeding at the groin site from catherization, however this resolved and an ultrasound did not reveal any abnormalities at the time. patient also underwent cta to rule out dissection and pulmonary embolism given her complaint of back pain in addition to her ekg changes. no pulmonary embolism or dissetion were noted. she had no further episodes of pain. . # atrial fibrillation: patient has a history of chronic, paroxysmal atrial fibrillation, and is chroncially on coumadin. she also has a history of stroke. she remained in sinus rhythm during her stay with occasional bradycardia. her digoxin was held in the setting of her occasional bradycardia. her coumadin was re-started prior to discharge. - she will need an inr/ptt/pt check within 2-3 days after discharge, and then every 1-2 weeks (she should resume her pre-hospitalization inr checks as prescribed by her regular providers). her goal inr is . . # hypertension: patient's blood pressure was brought under much better control during her stay, initially with a nitroglycerin drip. her regimen included losartan (she has a listed allergy to ace-inhibitors, although does not know any of the details) and atenolol. prior to discharge, her systolic blood pressure ranged between 90-120. - she may need additional titration of her blood pressure medications either during her rehabilitation stay, or during follow up with her primary care physician. . # diastolic dysfunction: patient has a history of hyperdynamic ejection fraction with impaired relaxation on echo from 5/. she had no evidence of failure on admission exam. a repeat echo druing this admission demonstrated a preserved ef (>55%). her beta-blocker and losartan were continued, and she did not need any diruesis. she is not on any lasix or other diuretic at home. . # right iliac artery aneurysm: the cta completed to rule out dissection or pulmonary embolism demonstrated a 2.4 x 2.4 cm right iliac artery aneursym (slightly larger than 2.2 x 1.7cm seen on prior scan ), with extensive thrombus associated with this. - patient continued on her anticoagulation for her history of atrial fibrillation. - vascular surgery follow up within the next month was arranged. . # disposition: physical therapy evaluated the patient, and rehabilitation was recommended. . # patient was full code during her stay. medications on admission: alendronate dosage uncertain atorvastatin 20 mg once a day digoxin - 125 mcg -once a day escitalopram 5 mg once a day meloxicam - 7.5 mg tablet - once a day pantoprazole 40 mg once a day warfarin - 2.5 mg tablet - once a day as directed by md aspirin - 81 mg once a day discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 7. losartan 25 mg tablet sig: one (1) tablet po daily (daily). 8. warfarin 2.5 mg tablet sig: one (1) tablet po hs (at bedtime). 9. escitalopram 5 mg tablet sig: one (1) tablet po once a day. 10. fosamax oral 11. atenolol 25 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: - chest pain secondary diagnoses: - atrial fibrillation - iliac artery aneurysm - hypertension discharge condition: stable. discharge instructions: you were admitted after having chest pain. a number of studies were done to evaluate your chest pain, including cardiac catherization and imaging studies. no blockages that needed intervention were seen on your cardiac catherization, and your imaging studies were within normal limits. your pain resolved and a few medication changes were made. . please take all medications as prescribed. . please call your cardiologist, primary care physician, go to the emergency room if you experience any chest pain, difficulty breathing, fevers, bleeding, numbness or weakness, or other concerning symptoms. . please note the following medication changes: - digoxin was stopped. - atenolol was started. - losartan was started. - meloxicam was stopped (to protect your kidneys). - atorvastatin was increased. - aspirin was increased. followup instructions: please follow up with your cardiologist, dr. on , at 3:40 pm. please call him if you feel you need an earlier appointment. . you will need to follow up vascular surgery clinic for abnormal findings noted on your imaging studies (a right iliac artery aneurysm). an appointment has been made for you with dr. on , at 2:00 pm. the office is located in the , . . an appointment has been made for you on with dr. , on at 2:15 pm, to follow up after you leave rehabitation.you may need further medication adjustments for your blood pressure treatment. procedure: coronary arteriography using two catheters left heart cardiac catheterization diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension atrial fibrillation personal history of malignant neoplasm of breast long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits aneurysm of iliac artery acute coronary occlusion without myocardial infarction 

Answer: The patient is high likely exposed to