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: amoxicillin attending: chief complaint: chest pain major surgical or invasive procedure: pci w/thrombectomy and bms placement in rca history of present illness: the patient is a 70 yo woman with h/o metastatic pancreatic cancer s/p chemotherapy (cycle 13 of gemcitabine) yesterday who presented to the ed with chest pain. she reportedly woke up at midnight with sharp sub-sternal 10/10 chest pain. she took maalox without improvement. she had associated sob and diaphoresis, but no nausea or abdominal pain. she called ems at 5 am. ems noted ste in ii, iii and avf with reciprocal changes in i and avl. . in the ed, her initial vs were t 98.3, p 96, bp:125/68, r 19, and o2 100% on ra. she was given asa 325 mg and morphine. her ekg showed ste in ii, iii, and avf, with deep depressions in i and avl and v2, so she was started on plavix and a heparin gtt and was sent to the cardiac cath lab. in the cath lab, patient was found to have a proximally occluded rca and underwent thrombectomy and bms placement. lad and lcx were normal. during the case, patient was hypotensive, suggestive of a rv infarct, and receieved atropine and dopamine for sbp 60/40. she was noted to have a fair sized hematoma around her sheath. she was stabilized and transferred to the ccu with sbps in the 90s. right heart catheterization showed ra 19, pcwp 16, cdi 2.15. . on the floor, patient feels well and denies any complaints. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he 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 some doe, which she attributes to chemotherapy, and the 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: - cabg: none - percutaneous coronary interventions: none - pacing/icd: none 3. other past medical history: - locally advanced pancreatic cancer with radiologic evidence of metastases to lungs, on gemcitabine chemotherapy gerd s/p appendectomy s/p hysterectomy . social history: lives alone , finds support in her son who lives in . he is hcp. - tobacco: 30 pack years, quit approx 1 month ago - etoh: denies . family history: - no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. . physical exam: on admission to ccu: general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. dry mucus membranes. neck: supple with jvp of 14 cm, hepatojugular reflex to ear 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 anteriorly, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. well healed subcostal scar. no hsm or tenderness. active bs extremities: bleeding around r femoral cath site; non tender; no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: 2+ radial pulses; dopplerable dps . pertinent results: - laboratory data: wbc: 6.8 hgb/hct: 10.3/30.8 (hct 31.7 on outpatient labs, yesterday)plt 366 . 142 | 113 | 21 / 175 4.8 | 18 |1.2 \ . pt/ptt/inr: 15.3/150/1.3 . ck: 250 ckmb: **** tnt: 0.24 . abg: ph7.33 pco239 po2119 hco321 basexs-4 - ecg: 5:44 am: sinus at 94 bpm. ste in ii, iii, avf with depressions in i, avl and v2. . - echo (): the left atrium and right atrium are normal in cavity size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. impression: normal global and regional biventricular systolic function. mild to moderate mitral regurgitation and mild aortic regurgitation. . . brief hospital course: 70 year old woman with h/o metatstatic pancreatic cancer who presented from home with chest pain consistent with inferior stemi, now status post thrombectomy and bms to proximal rca. . # stemi: pt now s/p inferior/rv stemi with some hemodynamic instability in cath lab, s/p thrombectomy and bms to rca. she had some hemodynamic instability in the cath lab requiring dopamine and atropine, these were attributed to a vagal reperfusion response in the setting of stenting her rca occlusion. she remained asymptomatic and hemodynamically stable throughout the remainder of her hospitalization. after pci, she was continued on integrellin for 18 hours. she was started on plavix and aspirin which she was instructed to continue taking daily until otherwise told by dr. . she was started on atorvastatin 80 mg which was switched to crestor 40 mg daily on discharge- lipid panel was checked (see below). patient had a post-mi echocardiogram which showed an ef of 40-45% and regional biventricular systolic dysfunction, c/w inferior and rv myocardial infarction. she will follow up with dr. . . # pump: s/p inferior/rv stemi with hemodynamic instability in cath lab requiring atropine and dopamine. this transient response was attributed to reperfusion of her rca after stenting. she remained hemodynamically stable for the remainder of her hospitalization. she was gradually started on metoprolol and lisinopril and had an echocardiogram (see above). . # rhythm: was monitored on telemetry and remained in sinus rhythm. . # htn - remained normotensive after her rv mi without any periods of hypotension. her home hctz was discontinued and she was started on lisinopril 5 mg daily. her metoprolol was downtitrated to 37.5 mg daily in the extended release formulation. . # hld - lipid panel showed hdl of 19 and ldl of 85. was discharged on crestor 40 mg daily. . # pancreatic cancer- metastatic with presumed involvement of lungs on ct chest. is now s/p cycle 13 of gemcitabine on with discussion of different regimens in the future pending response. patient's oncologist dr. was notified of her admission and follow up was scheduled for . she did not become neutropenic during this admission. . # : creatinine of 1.2 on admission, up from baseline of 0.8-1.0. likely secondary to pre-renal etiology in setting recent mi as it improved to baseline with fluid rehydration. . # anemia: patient presented with chronic anemia at baseline around 31, likely secondary to cancer and chemotherapy. her hematocrit trended down to 22.3 during this admission- ct abdomen/pelvis was done and negative for a rp bleed. there no significant groin hematoma. she received 2 units prbcs and hematocrit remained stable thereafter. . code: patient's dnr/dni was suspended for this admission given her recent mi. she was discharged w/ dnr/dni reactivated. medications on admission: home medications (per oncology clinic note, confirmed w/ pt): hctz 25 mg daily creon 6000-- unit capsules, 2 caps tid metoprolol tartrate 37.5 mg po bid prochlorperazine 10 q6h prn nausea acetaminophen prn ibuprofen prn discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): do not stop tkaing unless dr. tells you to. disp:*30 tablet(s)* refills:*2* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. rosuvastatin 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 5. tylenol 325 mg tablet sig: 1-2 tablets po three times a day as needed for pain. 6. creon 6,000-19,000 -30,000 unit capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po three times a day. 7. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 8. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. metoprolol succinate 25 mg tablet extended release 24 hr sig: 1.5 tablet extended release 24 hrs po once a day. disp:*45 tablet extended release 24 hr(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: st elevation myocardial infarction hypertension hyperlipidemia pancreatic cancer discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking part in your care. you had a heart attack and needed a cardiac catheterization which showed a blockage in your right coronary artery. this blockage was opened and a stent was placed to keep it open and prevent another heart attack. you will need to take a full dose aspirin every day and plavix to prevent the stent from clotting off and causing another heart attack. do not miss or stop taking aspirin and plavix unless dr. tells you to. your blood count was low after the procedure and we did a ct scan to check for bleeding, it did not show any bleeding. you recieved 2 units of blood for your anemia. please follow the activity restrictions that the physical therapist discussed with you. . we made the following changes to your medicines: 1. start taking aspirin 325 mg and plavix 75 mg daily for at least one month 2. change the metoprolol to 37.5 mg daily and change to a once a day formulation 3. start taking crestor again to lower your cholesterol 4. stop taking ibuprofen, take tylenol instead for any pain 5. stop taking hydrochlorothiazide for now 6. start taking lisinopril 5mg to help your heart recover from the heart attack. followup instructions: . cardiology: 09:30a dr. clinical center, cc7 cardiology (sb) . department: hematology/oncology when: monday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: monday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: monday at 12:00 pm with: , rn building: campus: east best parking: garage name: , location: medical associates, pc address: , , phone: appointment: wednesday at 12:30pm procedure: insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension acute kidney failure, unspecified personal history of tobacco use other and unspecified hyperlipidemia acute myocardial infarction of other inferior wall, initial episode of care secondary malignant neoplasm of lung malignant neoplasm of other specified sites of pancreas 

Answer: The patient is high likely exposed to