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: sulfa (sulfonamide antibiotics) / vasotec / pletal attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization with angioplasty and drug eluting stent to left main coronary artery and left anterior descending artery history of present illness: 83 yo with hx of as s/p bioprosthetic avr x 2, rima to rca in presented to center on with cp. she reported worsening of indeigestion with heartburn x 2 weeks with the episodes of dull chest discomfort becoming more constant. she was put on a ppi by her pcp without effect. over several days her sxs have become worse with burning chest discomfort without associated sob. she has 6 pillow orthopnea from 3 due to worse sxs at night. her chest discomfort is worse with activity. day prior () to admission she developed severe heartburn and cp which radiated to both arms with numbness and tingling of both arms as well. it was associated with sob, diaphoresis, lightheadedness, and eventual vomiting. she has also had increasing fatigue and weakness. she called ems at that point and was relieved with oxygen. . initial osh ekg showed: old rbbb with new twi in v2-v3 and iii and increased diffuse st depressions. st elevations in avr. initial troponin was 0.1 which increased to 1.85 on at 720am. she was started on iv heparin on the am of . . patient had cp at 330 am on relieved by increasing nitro gtt. cardiac catheterization on showed 98% discrete distal left main disease, 90% proximal/mid/distal rca, patent rima-distal rca, 85% mid right external iliac stenosis. lad and circumflex were poorly visualized. she was started on a nitro gtt, high dose liptor, lopressor and norvasc. she was given lasix iv for evidence of chf on cxr and an elevated bnp to 2810. she is +1.2 l due to ivf for renal protection. . she had a hct drop from 34 to 28 which was rechecked and 24 on day of transfer. her creatinine was elevated at 1.8 (basline unknown). . on the floor, patient had developed chest discomfort while on a heparin gtt and nitro gtt, which could not be put to max dose due to limitations to what can be administered on the general wards. the patient's chest discomfort relived on its own. . additionally, patient was found to have brbpr on rectal examination, although no bloody bowel movements. . on transfer, patient is cp free. past medical history: cardiac risk factors: +hypertension - aortic stenosis: unknown valve area: - avr with periprostheic ar - rima to rca - pvd with venous stripping rle remote and intermittent claudication - basal cell carcinoma - renal insufficiency stage iii-iv : 1.82 baseline; : 1.39, 1.48 - acd - gerd - ibs - b/l cataracts colonscopy <5 years ago negative and told to return in 10 years; colonscopies previously with polyps social history: widowed with currently 3 living children. she lives alone in an apartment and does own adls. hx of tobacco use (25 pack-years, quit >10 years ago). no etoh. uses a cane. family history: strong cad with entire mother's side having heart problems. she is children and 6 siblings have died of heart related problems. she also has a son who died of a sudden mi at age 52. physical exam: gen: nad. oriented x3. mood, affect appropriate. speaking comfortably in full sentences. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink. neck: supple with jvp of 8 cm. cv: nondisplaced pmi. rr, normal s1, s2. 3/6 sem radiating to carotids. chest: resp were unlabored, no accessory muscle use. crackles at bases b/l l>r. abd: soft, ntnd. no hsm or tenderness. ext: trace le pitting edema. b/l femoral bruits. warm and well perfused. 2+ dps. pertinent results: 02:00pm wbc-8.5 rbc-2.73* hgb-8.5* hct-25.1* mcv-92 mch-31.2 mchc-33.9 rdw-12.8 02:00pm neuts-76.7* lymphs-17.0* monos-4.3 eos-1.6 basos-0.4 02:00pm ck(cpk)-26* 02:00pm ck-mb-notdone ctropnt-0.26* 02:00pm pt-12.3 ptt-29.6 inr(pt)-1.0 02:00pm glucose-101* urea n-38* creat-1.7* sodium-139 potassium-3.8 chloride-97 total co2-34* anion gap-12 09:54pm calcium-8.4 phosphate-2.2* magnesium-2.5 02:39pm dipstick urinalysis: blood neg, nitrite neg, protein tr, glucose neg, ketone neg, bilirub neg, urobiln neg, ph 6.5, leuks lg microscopic urine examination rbc 1, wbc 54, bacteria few, yeast none, epi 0 2:39 pm urine culture (preliminary): gram negative rod(s). >100,000 organisms/ml. . ecg: normal sinus rhythm, rate 78. right bundle branch block. non-specific inferolateral repolarization changes. no previous tracing available for comparison. . arterial duplex lower extremity u/s: there is significant calcified plaque bilaterally within the right and left common femoral and superficial femoral arterial distributions, now with elevated velocities within the superficial femoral arteries bilaterally. . ct abdomen pelvis: 1. no evidence of retroperitoneal hemorrhage. 2. multiple well-circumscribed bilateral renal lesions, some of which may represent simple cysts, though with some incompletely characterized and correlation with prior imaging is recommended, and if no prior imaging is available, a renal ultrasound can be performed on a non-emergent basis for further evaluation. 3. extensive atherosclerotic calcification and disease with associated luminal narrowing that is incompletely assessed on this non-contrast imaging study. . tte: mild symmetric left ventricular hypertrophy with normal global and regional biventricular systolic function. aortic valve bioprosthesis with thickened leaflets and abnormally-elevated gradients. mild calcific mitral stenosis. moderate to severe mitral regurgitation. moderate tricuspid regurgitation. moderate pulmonary hypertension. . cardiac catheterization: 1. limited coronary angiography in this right dominant system demonstrated three vessel disease. the lmca had a distal 90% stenosis. the lad had a 90% mid vessel stenosis. the rca was not injected. 2. abdominal aortography revealed mild bilateral renal artery stenosis. the iliac arteries were severely calcified and tortuous with a 70% right and 60% left common iliac stenosis. 3. successful ptca and stenting of the lmca with a 4.5 x 13mm ultra bare metal stent which was postdilated to 5.0mm. final angiography revealed no residual stenosis, no angiographically apparent dissection, and timi 3 flow. 4. successful ptca and stenting of the mid lad with a 3.0 x 15mm vision bare metal stent which was postdilated to 3.5mm. final angiography revealed no residual stenosis, no angiographically apparent dissection, and timi 3 flow. . renal ultrasound impression: 1. bilateral simple cysts measuring up to 1.7 cm. 2. number of echogenic foci in the lower pole of the left kidney, the largest measuring 0.6 cm consistent with stone. 3. bilateral small amount of pleural effusion. 4. small amount of ascites. brief hospital course: 83 year-old female with past medical history of as, cad s/p 1v transferred from osh with 98% left main disease s/p bms to lmca and mid lad. she was transferred back to hospital in on for further care because it is closer to home, so that her family can visit her more easily. #. cad: the patient presented from an outside hospital with severe left main stenosis of 98%. the patient underwent a catheterization at the outside hospital. she was transfused 1u prbc to a goal of 30. she was weaned off the nitroglycerin drip and her blood pressures were controlled with metoprolol tartrate and hydralazine. she was on high dose atorvastatin. she had back pain and had a ct abdomen and pelvis which was negative for rp bleed. her ekg was stable from the osh and she was monitored on telemetry. she underwent a high risk pci with a bare metal stent placed in the lmca and lad. she was maintained on aspirin and plavix. plavix should be continued for at least a month and should only be stopped by her cardiologist. aspirin should be continued indefinitely and should only be stopped by her cardiologist. she was discharged on a beta blocker and hydralazine. when her kidney function returns she may warrant addition of an ace inhibitor to regimen. she will need an appointment with her cardiologist in the near future that has been scheduled. #. acute on chronic kidney disease: the patient has an unclear baseline creatinine, which may be around 1.4. the patient had a dye load from the osh and a dye load during her catheterization procedure and developed an acute kidney injury about 48hours after the procedure, which appears to be contrast-induced nephropathy. her ua and microscopy show rare eosinophils, which is concerning for cholesterol emboli, however, no systemic signs of this. her fena was suggestive of a pre-renal picture. her creatinine increased to 3.4 at the day of transfer. she was given 1.5l of iv fluid without response in creatinine. she may benefit from a nephrology consult on transfer. she should also follow up with her nephrologist as well in the near future. a renal ultrasound showed no hydronephrosis or obstruction but did show a number of echogenic foci in the lower pole of the left kidney, the largest measuring 0.6 cm consistent with stone. #. hyponatremia: the patient developed hyponatremia when her creatinine began to worsen. her low sodium was 121. she was given 1.5l ns with elevation of her sodium to 126. she was started on salt tablets briefly with elevation of her sodium to 127. this will need to be closely monitored. #. guaiac positive stool: the patient presented with a history of dark stools. she also had a dark stool which was guaiac positive in house. she was transfused 1 u of prbc the day of discharge for a hematocrit of 26. she remained hemodynamically stable. she should remain on aspirin and plavix due to recent stent placement but egd may be indicated if hct cont to fall. #. urinary tract infection: the patient had a positive ua and urine culture with gram negative rods, sensitivities pending. she has had a foley place intermittently and thus should continue with a 7 day course of antibiotics. she was transferred on ceftriaxone with day 1 being . she should see her primary care phsyician in the near future. #. urinary retention: the patient had a post void bladder scan with 350cc of urine remaining in her bladder. a foley catheter was placed. the foley catheter had been removed and the patient was urinating without difficulty at discharge. #. hypertension: she was well controlled on metoprolol tartrate and hydralazine. ace inhibitor should be considered when her kidney function improves. #. peripheral vascular disease: stable. held pentoxifylline. #. code status: patient was full code during this hospitalization. #. family contact: daughter at cell medications on admission: at home: pentoxifylline 400mg tid toprol xl 50mg daily enalapril 5 mg daily lasix 40mg daily asa 81 mg daily ferrous sulfate 325mg daily tylenol #3 one daily on transfer: iv nitroglycerin at 180 mg/min (850) iv heparin at 850 u/hr norvasc 5mg daily acetylcysteine 1200 mg q12h metoprolol 25mg q6h lipitor 80mg daily plavix load 300mg, now on 75mg daily enalapril 5mg daily ferrous sulfate 325mg daily lasix 40mg daily (on hold) mvi daily protonix 40mg pentoxifylline 400mg tid tylenol #3, 1 tab daily discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for acid reflux. 5. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 7. metoprolol tartrate 50 mg tablet sig: one (1) tablet po q6h (every 6 hours): hold hr< 60. 8. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 9. hydralazine 50 mg tablet sig: one (1) tablet po qid (4 times a day): hold sbp < 100. 10. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain, fever: max 3 grams per day. 11. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for heartburn, dyspepsia. 12. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 13. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 14. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 15. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 16. ceftriaxone 1 gram piggyback sig: one (1) gram intravenous once a day for 7 days: first day , last day . 17. bisacodyl 10 mg suppository sig: one (1) suppository rectal once a day as needed for constipation. 18. ferrous sulfate 325 mg (65 mg iron) capsule, sustained release sig: one (1) capsule, sustained release po once a day. discharge disposition: extended care discharge diagnosis: coronary artery disease hypertention acute on chronic kidney disease acute blood loss anemia discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: you had a high risk cardiac catheterization and a bare metal stent was placed in your left main coronary artery. the procedure went well but you received a large amount of contrast that has caused your kidneys to stop working. we have given you fluid to support your kidneys and have been following your electrolytes closely. a kidney ultrasound was done and results are pending at this time. you also are losing some blood in your stool and have received 2 units of blood to treat your anemia. you will need to stay on aspirin and plavix for at least one month and possibly longer. do not stop taking plavix or miss s without speaking to dr. or dr. about this. you risk having another fatal heart attack if you stop taking aspirin and plavix. . medication changes: 1. start taking aspirin and plavix every day to prevent the stent from clotting off 2. stop taking enalapril and lasix until kidney function improves. 3. stop taking pentoxifylline until your kidney function improves. 4. metoprolol succinate changed to metoprolol tartrate while hospitalized 5. start hydralazine and amlidipine to control your blood pressure. 6. start famotidine to prevent bleeding in your stomach 7. start ceftriaxone to treat your urinary tract infection 8. start heparin sc to prevent blood clots 9. start trazadone to help you sleep at night 10. start atorvastatin to control your cholesterol 11. you were started on colace, bisacodyl for your constipation followup instructions: primary care: , n. phone: date/time: please make an appt to see 1 week after discharge from catholic . cardiology: phone: ( date/time: please keep your scheduled appt. procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters left heart cardiac catheterization arteriography of femoral and other lower extremity arteries aortography transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: anemia of other chronic disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified hyposmolality and/or hyponatremia atherosclerosis of native arteries of the extremities with intermittent claudication chronic kidney disease, stage iv (severe) atherosclerosis of aorta hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortocoronary bypass status other chronic pulmonary heart diseases personal history of tobacco use chronic kidney disease, unspecified atherosclerosis of renal artery personal history of other malignant neoplasm of skin blood in stool chronic systolic heart failure retention of urine, unspecified family history of ischemic heart disease heart valve replaced by transplant irritable bowel syndrome tricuspid valve disorders, specified as nonrheumatic personal history of colonic polyps other drugs and medicinal substances causing adverse effects in therapeutic use atherosclerosis of other specified arteries 

Answer: The patient is high likely exposed to