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: chest pain major surgical or invasive procedure: coronary artery bypass grafting x4: left internal mammary artery to left anterior descending with saphenous vein grafts to ramus, obtuse marginal and plv. cardiac catheterization with intra aortic ballon pump placement history of present illness: 78 y.o man with history of dm, ckd and hyperlipidemia who presented to with stuttering chest pain of 3 days duration. the patient's pain was intermittent, squeezing in nature, and radiated to his neck and he initially felt that it was gastrointestinal in nature. when the pain became worse he presented to the emergency room. there, he was found to have an ekg concerning for an anterior stemi with st elevations in v1-v3 as well as in avr. he was then transferred to for further therapy. . he was brought to the cardiac catherization lab and catheterization demonstated severe multivessel disease. no intervention was performed. an intra aortic balloon pump was placed. cardiac surgery was contact for evaluation for coronary bypass grafting. past medical history: past medical history: peptic ulcers insulin dependent diabetes mellitus x 20 years high cholesterol chronic renal insufficeny diabetic neuropathy past surgical history: right thigh cyst removal social history: lives alone. sexually active with a girlfriend. monogamous relationship. retired french/spanish teacher. denies heavy etoh, one beer occasionally, +tobacco/ 1 ppd for 60years. no regular exercise. family history: no cad. positive for dm in mother. physical exam: admission exam tmax: 36.4 ??????c (97.6 ??????f) tcurrent: 36.4 ??????c (97.6 ??????f) hr: 63 (63 - 73) bpm bp: 126/51(80) {126/41(71) - 150/59(100)} mmhg rr: 12 (11 - 15) insp/min spo2: 100% heart rhythm: sr (sinus rhythm) general: wdwn man in 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. neck: supple with jvp of 2 cm. cardiac: quiet heart sounds with background noise from iabp. normal s1/s2, no murmurs, rubs gallops. lungs: clear to auscultation bilaterally in axillae and anteriorly. abdomen: soft, non-tender, non-distended with bowel sounds present. pulses: bilateral dps dopplerable groin: iabp sheath in right groin. no evidence of hematoma or bleeding from site.neurologic: responds to: not assessed, movement: not assessed, tone: not assessed pertinent results: admission labs: 09:30am blood wbc-6.4 rbc-4.84 hgb-13.3* hct-41.2 mcv-85 mch-27.5 mchc-32.3 rdw-15.4 plt ct-185 09:30am blood neuts-77.9* lymphs-15.2* monos-3.4 eos-2.9 baso-0.6 09:30am blood pt-12.5 ptt-52.8* inr(pt)-1.1 09:30am blood glucose-294* urean-38* creat-2.3* na-139 k-4.6 cl-103 hco3-24 angap-17 09:30am blood albumin-4.0 calcium-9.1 phos-2.5* mg-2. 09:30am blood alt-18 ast-20 ld(ldh)-171 alkphos-28* amylase-7 totbili-0.1 03:20pm blood %hba1c-7.3* eag-163* cardiac enzymes: 06:15pm blood ck(cpk)-315 12:59am blood ck(cpk)-318 07:50am blood ck(cpk)-430* 09:30am blood ctropnt-0.19* 06:15pm blood ck-mb-15* mb indx-4.8 ctropnt-0.73* 05:10am blood ck-mb-13* ctropnt-1.02* 12:59am blood ck-mb-15* mb indx-4.7 ctropnt-0.75* 07:50am blood ck-mb-23* mb indx-5.3 ctropnt-0.99* discharge labs: 04:40am blood wbc-6.7 rbc-3.43* hgb-9.9* hct-28.5* mcv-83 mch-28.9 mchc-34.7 rdw-14.8 plt ct-213 09:33am blood pt-13.0 inr(pt)-1.1 04:40am blood plt ct-213 04:40am blood glucose-221* urean-92* creat-4.3* na-140 k-4.3 cl-101 hco3-26 angap-17 creat 3.7; inr 1.9 (rec'd 2.5 mg coumadin) cardiac cath () 1. selective coronary angiography in this right dominant system demonstrated left main and three vessel coronary artery disease. the left main coronary artery had 50% stenosis. the lad had a 70% ostial and 90% mid vessel stenosis. the lcx had a 70% proximal stenosis. the ramus had an ostial 80% stenosis. the rca had sequential mid and distal 80% lesions. 2. limited resting hemodynamics demonstrated elevated left sided filling pressures with lvedp 18 mmhg. there was normal systemic arterial pressure with central aortic pressure 110/63 with a mean of 57 mmhg. 3. successful placement of iabp. final diagnosis: 1. three vessel coronary artery disease. 2. left ventricular diastolic dysfunction. 3. successful placement of iabp. ===================================== echo () the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild to moderate regional left ventricular systolic dysfunction with mid to distal anteroseptal akinesis, apical akinesis, mid to distal anterior hypokinesis/akinesis and basal inferior hypokinesis. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. carotid ultrasound () impression: right ica <40% stenosis. left ica <40% stenosis. brief hospital course: 78 yo man with hx of dm, ckd and hld presents from osh with chest pain x3 days found to have stemi (st elevations in v1-v3), brought for cardiac catheterization and found to have 3vd. no stents were placed. an iabp was placed to improve cardiac output in the setting of hypotension. the pt was medically managed with aspirin 325 mg daily, metoprolol 12.5 , rosuvastatin 40 mg daily, and heparin gtt. given severe 3vd, cardiac surgery was contact for evaluation for coronary bypass grafting. no plavix was given in anticipation for revascularization. the following day the intra aortic balloon pump was successfully weaned and removed with stable blood pressures. a small hematoma developed in the right groin which slowly resolved, the hematocrit remained stable. coronary bypass workup was completed, however surgery was delayed 2 days due to elevated creatinine which returned to baseline prior to procedure. the patient remained chest pain free since cardiac catheterization with the exception of fleeting chest pain on . ekg showed findings similar to presenting ekg. chest pain spontaneously resolved without intervation. on the patient was brought to the operating room for coronary bypass grafting, please see the operative report for details. in summary he had: coronary bypass grafting x4 with left internal mammary artery to the left anterior descending artery and reverse saphenous vein graft to the posterior left ventricular branch artery, obtuse marginal artery, ramus intermedius artery. his bypass time was 100 minutes with a crossclamp time of 89 minutes. he tolerated the operation well and post-operatively was transferred to the cardiac surgery icu. hemodynamically he was somewhat labile in the immediate post-op period and was kept sedated on the day of surgery to provide opportunity for transfusion/volume resuscitation and stabilization. attempted to wake patient on morning of pod1, at that time he was very agitated and sedation was switched to precedex without much effect. he was weaned from the ventilator but remained agitated and was not extubated until later in the afternoon. following extubation he required additional pulmonary support, additionally his creatinine which was elevated post cardiac catheterization was again elevated, consistant with acute on chronic renal failure. the creatinine peaked at **4.3*** from his baseline of 2.0. at the time of discharge on pod#9 his creat was trending downward and was 3.7 on day of discharge. he was hemodynamically stable but remained in the icu to monitor his pulmonary and renal status until pod4. all tubes lines and drains were removed per cardiac surgery protocol. the patient was started on coumadin because of low ef, he continues to exhibit signs of systolic heart failure by cardiac echocardiogram done . the patient worked with the nursing staff and physical therapy to increase his strength and endurance and was making slow progress however he will likely benefit from short rehabilitation stay prior to returning to his home environment. on pod # 9 he was discharged to health center in his affect is a bit eccentric and impatient occasionally calling out- wears dark glasses with claims that he is sensitive to light. in general he is calm and cooperative. his pain is managed with low dose neurontin and tylenol- no narcotics. medications on admission: insulin 75/25 50u qam, 50u qpm gabapentin 300mg tid rosuvastatin 10mg daily terazosin 0.4mg qhs aspirin daily vitamin d3 400mg daily omeprazole 40mg daily discharge medications: 1. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 2. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever/pain. 6. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 7. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 8. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 9. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 10. gabapentin 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 12. rosuvastatin 5 mg tablet sig: two (2) tablet po daily (daily). 13. warfarin 1 mg tablet sig: dose per inr tablet po daily (daily): indication - low ef goal inr 2.0-2.5. 14. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 15. insulin 75/25 30 units qam 16. insulin regular insulin per sliding scale based on finger stick discharge disposition: extended care facility: health care center - discharge diagnosis: coronary artery disease - s/p coronary artery bypass graft x 4 past medical history: dyslipidemia chronic renal insufficiency insulin dependent diabetes mellitus benign prostatic hypertrophy hypertension discharge condition: alert and oriented x3 nonfocal ambulating independently with steady gait incisional pain managed with tylenol incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema:trace discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for one month or while taking narcotics. driving will be discussed at follow up appointment with surgeon. no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. on at 1:00pm in the medical office building cardiologist/pcp: . on at 3:15pm coumadin indication: low ef. goal inr 2.0-2.5 check inr mon/wed/fri until therapeutic then weekly. please arrange follow up for coumadin upon discharge from rehab. **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery left heart cardiac catheterization coronary arteriography using a single catheter implant of pulsation balloon diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux tobacco use disorder acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified acute posthemorrhagic anemia acute myocardial infarction of other anterior wall, initial episode of care atrial fibrillation hematoma complicating a procedure polyneuropathy in diabetes hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified 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 acute systolic heart failure diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled other premature beats 

Answer: The patient is high likely exposed to