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: patient recorded as having no known allergies to drugs attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization with angioplasty and stenting intra-aortic balloon pump endotracheal intubation history of present illness: 73-year old white male with pmh of afib and sciatica who presents from with stemi and vfib arrest. around 9 am of during breakfast, pt had feeling of gaseous discomfort and reportedly had diffuse chest pain with radiation into both arms. 10:03 am - , elevations precordium (no ekg, lead strip), given beta blockade, morphine, , nitro, plavix 600, set for transfer to . trops(-), cr 1.4, h/h, 12.6/38.3, hr 127-135, sbps 111-132/80-89. 10:29 am - vfib arrest (on lead strips) w/subsequent cpr and defib x5 cycles, with asystole and pea. received epinephrine x 3, atropine x 1, lidocaine drip. 11:00 am transport to ed 11:20 arrival - vfib arrest, continued cpr. epi, atropine, transcutaneously pace at 80. transferred to cath lab. 11:52 arrives in cath lab, integrillin initiated 12:36 stent deployed past medical history: afib social history: retired fire-fighter. no active smoking. lives with wife physical exam: upon arrival to ccu: 85/50, 83, 96.8, ac 700 22, fio2 80%, plat 22. intubated, sedated, pinpoint pupils, mmm obese neck, no carotid bruits appreciated cardiac: nsr, could not appreciate any murmurs iabp lungs: cta bil pulses intact bil no edema pertinent results: 02:57pm blood wbc-26.5* rbc-4.65 hgb-14.1 hct-41.2 mcv-89 mch-30.4 mchc-34.3 rdw-14.6 plt ct-408 02:57pm blood glucose-230* urean-24* creat-1.3* na-137 k-4.7 cl-110* hco3-19* angap-13 02:57pm blood ck(cpk)-504* 09:00pm blood ck(cpk)-1174* 04:56am blood ck(cpk)-1573* 02:00pm blood ck(cpk)-1714* 08:51pm blood ck(cpk)-1693* 03:48am blood ck(cpk)-1512* 01:10am blood ck(cpk)-* 06:52am blood ck(cpk)-1602* 05:30am blood ck(cpk)-283* 02:57pm blood ck-mb-65* mb indx-12.9* ctropnt-1.10* 09:00pm blood ck-mb-135* mb indx-11.5* ctropnt-2.30* 04:56am blood ck-mb-112* mb indx-7.1* ctropnt-3.20* 02:00pm blood ck-mb-56* mb indx-3.3 ctropnt-2.26* 08:51pm blood ck-mb-31* mb indx-1.8 ctropnt-2.14* 03:48am blood ck-mb-19* mb indx-1.3 ctropnt-1.84* 01:10am blood ck-mb-114* mb indx-5.9 06:52am blood ck-mb-76* mb indx-4.7 05:34am blood ck-mb-20* mb indx-3.2 05:30am blood ck-mb-9 04:25pm blood alt-112* ast-182* ld(ldh)-587* ck(cpk)-1660* alkphos-73 totbili-0.6 05:34am blood alt-80* ast-147* ld(ldh)-795* ck(cpk)-628* alkphos-79 totbili-0.8 hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 04:23am 16.0* 3.80* 11.6* 33.3* 88 30.6 34.9 15.0 373 . chemistry renal & glucose glucose urean creat na k cl hco3 angap 04:23am 98 25* 1.4* 139 4.8 102 30 12 . cardiac cath : ptca comments: the patient was emergently brought to the catheterization lab after undergoing cardiac arrest thrice at an outlying hospital and again en route to our facility. the patient was resuscitated in the emergency room and then brought to the cath lab after consulting with family members. initial angiogram demonstrated proximal total occlusion of the proximal lad. prior to proceeding with intervention a 40cc iabp was placed for hemodynamic support for during and post procedure afterload reduction and diastolic augmentation via standard technique through the righ common femoral artery. it was planned to treat the lesion with ptca and stenting. integrelin was the anticoagulant used during the procedure. a 6fxb lad 3.5 guide catheter provided optimal support. the lesion was crossed with a choice pt xs wire into the distal vessel. the lesion was pre-dilated with a 2.0 x 12 voyager balloon at low inflation and a quick cat extraction catheter was then advanced across the lesion twice due to the presence of thrombus. a 3.0 x 28 vision bms was then deployed at 16 atm and post dilated with a 3.0 x 20 quantum maverick at 20 atm. final angiography demonstrated no residual stenosis and no angiographic evidence of dissection, thrombus or perforation with timi iii flow in the distal vessel. patient left the lab on pressor support with dopamine, iabp, intubated and responsive only to painful stimuli. conclusions: 1. succesful primary ptca and stenting of the rladwith aa 3.0 bms with prior thrombectomy. post dilated with a 3.0 nc balloon. the final angiogram demonstrated no residual stenosis with no angiographic evidence of dissection, embolization or perforation with timi iii flow in the distal vessel with grade 2 blush. (see ptca comments) final diagnosis: 1. cardiogenic shock s/p cardiac arrest 2. successful primary pci of the lad. . echo - conclusions: the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is severe regional left ventricular systolic dysfunction with near akinesis of all segments except for the basal half of the inferior and inferiolateral walls which are hypokinetic. no masses or thrombi are seen in the left ventricle. right ventricular chamber size is normal with focal hypokinesis of the apical free wall. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: extensive regional left ventricular systolic dysfunction c/w proximal lad/lm disease. mild mitral regurgitation. . echo : conclusions: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with mid to distal anteroseptal/anterior/apical. overall left ventricular systolic function is moderately depressed. transmitral doppler and tissue velocity imaging are consistent with grade i (mild) lv diastolic dysfunction. no apical thrombus seen (cannot exclude). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . cardiac cath : 1. one vessel coronary artery disease due to sub-acute stent thrombosis. 2. severe elevation of right and left filling pressures. 3. aivr and junctional tachycardia with drop in blood pressure due to rate and loss of syncrony. 4. successful thrombetomy and angioplasty of a totally occluded lad with restoration of timi 3 flow. . echo : the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. no masses or thrombi are seen in the left ventricle. overall left ventricular systolic function is severely depressed with global hypokinesis and regional akinesis of the septum, anterior wall and apex. right ventricular systolic function is borderline normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the prior study (images reviewed) of , the overall lvef is lower. . echo : measurements: ef 20% (nl >=55%) left ventricle: normal lv cavity size. cannot exclude lv mass/thrombus. severely depressed lvef. lv wall motion: regional lv wall motion abnormalities include: basal anterior - akinetic; mid anterior - akinetic; basal anteroseptal - akinetic; mid anteroseptal - akinetic; anterior apex - akinetic; septal apex- akinetic; inferior apex - akinetic; lateral apex - akinetic; right ventricle: normal rv chamber size and free wall motion. pericardium: no pericardial effusion. . conclusions: the left ventricular cavity size is normal. a left ventricular mass/thrombus cannot be excluded. overall left ventricular systolic function is severely depressed. resting regional wall motion abnormalities include anteroseptal/anterior/apical akinesis. right ventricular chamber size and free wall motion are normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , there is no significant change. . mri/mra head : findings: there are scattered, ill-defined regions of restricted diffusion in the right frontoparietal cortex and right occipetal lobe, with corresponding t2 and flair signal hyperintensity. combined with mild hypodensity on corresponding ct in these regions, the findings suggest subacute infarction. no additional areas of restricted diffusion are seen. there is a tiny, solitary focus of susceptibility artifact in the left external capsule most consistent with hemorrhagic residuum. no intracranial mass lesion, hydrocephalus, or shift of normally midline structures are apparent. there is mucosal thickening in maxillary sinuses, bilateral scattered ethmoid air cells and bilateral sphenoid air cells, possibly related to prior intubation or inflammatory process. fluid is also seen in bilateral mastoid air cells. impression: 1. multiple right sided subacute infarcts in the right frontoparietal and occipetal lobes - involvement of more than one vascular territory suggests embolic phenomenon as the source of infarction. 2. sinus disease as described above. mra circle of : the major tributaries of the circle of are patent. there is no area of significant stenosis or aneurysmal dilatation. the basilar artery is slightly narrowed at its origin. irregularity along the cavernous portions of bilateral internal carotid arteries is most consistent with atherosclerosis. impression: no significant stenosis identified. . ct chest w/o contrast : ct of the chest without contrast: soft tissue window images demonstrate several prominent mediastinal lymph nodes, the largest measuring 11 mm in short axis diameter in the right peritracheal region (series 3, image 9) and a second prominent, but nonenlarged 8 mm lymph node (series 3, image 17). the prominent pretracheal lymph node (series 3, image 18) contains fat, and is likely benign. there is also a prominent ap window lymph node measuring 16 x 30 mm (series 3, image 20). there are bilateral pleural effusions, which are simple in appearance and hounsfield unit density measurements. no pericardial effusion is seen. a density is seen along the course of the lad, suggesting placement of prior stents. there is a right picc, with the tip positioned in the distal svc. lung window images demonstrate scattered areas of ground-glass opacity bilaterally, and areas of interlobular septal thickening at the lung bases independently. no focal consolidation or areas of cavitation are identified. no pneumothorax is seen. on the limited images of the superior portion of the abdomen, the patient is status post cholecystectomy. within the left lobe of the liver in a subcapsular position, there is a 3.8 x 2.2 cm mass (series 2, image 48), which demonstrates density of 50 hounsfield units on this noncontrast study. adjacent to this, there is a smaller focal area of low attenuation measuring 13 x 9 mm. the visualized portions of the adrenal glands, spleen, pancreas, upper kidneys, and stomach are within normal limits. bone windows: no suspicious lytic or sclerotic lesions are identified. degenerative changes are seen within the thoracic spine. impression: 1. bilateral pleural effusions, intralobular septal thickening, and scattered areas of ground-glass opacity are consistent with chf and pulmonary volume overload. a superimposed atypical infection is not entirely excluded. there is no evidence of cavitation. 2. several mildly prominent lymph nodes are noted within the mediastinum, which can be seen in the setting of chf and/or infection. 3. there is a 3.8 cm subcapsular mass within the left lobe of liver, which is not completely characterized on this study. further evaluation with an us or mri is recommended. . brief hospital course: in brief, the patient is a 73 year old man who was transferred from with an anterior stemi complicated by cardiogenic shock and vf arrest who was taken emergently to the cath lab for revascularization, course complicated by in-stent thrombosis and multiple extubations/re-intubations. . # cv: cad - patient was transferred from osh with stemi, initially loaded with plavix, acquired vfib arrest resulting in multiple rounds of cpr at osh and enroute to . patient transferred to cath lab emergently (see results) with stent/iabp placement, echo showing severe systolic dysfunction in anterior septal region, lad territory. heparin was held post-cath for concern for ugi due to ngt lavage with coffee grounds in ed with small drop in hct. on hd#3, pt transferred to cath lab emergently for st elevations in anterior leads, found to have in-stent thrombosis, thrombectomy and ptca performed, iabp replaced, heparin initiated, plavix loaded at 300mg, began 150mg qd. concern thrombosis to inadequate plavix loading at osh and while in-house due to lavage and question of decreased po absorption. patient was continued on his aspirin, statin, and plavix (75mg ) and also heparin drip over the course of his stay. two weeks post in-stent thrombosis, patient's heparin was bridged with coumadin, with plan for continued anticoagulation. patient should also be continued on plavix 75 mg po bid for a month and then uninterrupted for at least year and possible longer. the course at that point should be discussed with patient's cardiologist. patient should continue his lipitor 80 mg , 325, digoxin 0.625 qd, metoprolol xl 50 mg qd, and plavix 75 mg po bid x 30 days and then 75 mg qd thereafer. patient's captopril 25 mg tid was also switched to lisinopril 15 mg qd. pump - patient found to have ef of 20% with anteroseptal/anterior/apical akinesis, was aggressively diuresed on 40 iv lasix and will be d/c on lasix 20 po along with spiranolactone. he should also be evaluated in weeks for scd stratification with an echo, or alternatively, a signal averaged ekg and cardiac mri. rhythm - patient initially found to be in wide complex tachycardia with vf arrest with subsequent afib/aflutter and most recently with nsr with pac. patient's amiodarone was d/c due to concern for amiodarone toxicity and he was continued on digoxin. patient will follow up in electrocardiology clinic. # pulm: patient's airway was initially preserved with intubation and ventilator assistance in the setting of his cardiac code. patient self-extubated himself on the third hospital day, which preceded his in-stent thrombosis and re-intubation. patient was extubated one additional time with consequent reintubation, most likely secondary to mucus plugging or decreased respiratory drive due to remaining sedating medications. as per history, no intrinsic pulm disease was found to be limiting his pulmonary functionality, rsbis remained below 70 for days. patient was initiall treated for an aspiration pneumonia and then transitioned to treatment for hospital acquired pneumonia, see id discussion. due to some blood tinged sputum two weeks into his hospital stay and abnormal findings on his chest xray, a pulmonary consult was placed, with the recommendations to defer on bronchoscopy and following clinically. on hospital day 16, patient was successfully extubated without further complication or reintubation. patient was subsequently diagnosed with mrsa ventilation associated pneumonia as confirmed by sputum. he was treated with 13 days of vancomycin which was switched to linezolid on for a 7 day course. patient was also empirically covered with meropenem which was stopped after 7 days after no gram negative organisms were identified. patient remained afebrile although his wbc was slow to improve and remained upon discharge. patient may have also had a element of acute amiodarone toxicity which was contributing to his continued oxygen requirement. patient will require further physical therapy, spirometry and gradual titration of his oxygen demand. amiodarone as offending has been discontinued. the infection is likely to be resolving as patient remained afebrile without other source of leukocytosis. patient will need two further days of linezolid. . # gi: on hosptial day 1, patient had coffee ground emesis on nasogastric suctioning, which prompted holding patient's heparin administration. protonix dosing was initiated. throughout his stay, patient did not have any melanotic stools or overt bleeding from his uppper gi tract. while intubated, patient was given tube feeds when appropriate, initially with increased residuals, but then with improvement on an appropriate bowel regimen. his hematocrit remained stable upon discharge on 30-35. he was conservatively managed. . # id: patient acquired a leukocytosis early in his hospital course with a concurrent low grade temperature just below 100 degrees, save some intermittent spikes to 102. patient's panculture initially returned negative, save diptheroids on a blood culture. concern for aspiration pneumonia, patient was initiated on levofloxacin and flagyl treatment. patient's multiple sputum cultures returned as mrsa and patient was treatment for a hospital acquired pneumonia with vancomycin, concurrently with cefepime. due to woresning chest x-rays during his course, infiltrative findings in the rll and lml, cefepime was changed to meropenem. patient was continued on vancomycin, then linezolid and short course of meropemen as above. he remained afebrile throughout his stay without another clear etiology of fevers. . # neuro: initially it was difficult to determine patient's neurological functioning due to sedation. as patient was being intermittently weaned off sedation, there was question whether patient was appropriately moving his extremities and responding appropriately, which prompted an mri, revealing watershed infarcts vs emboli in the right frontoparietal and occipital lobes.t delayed. continued concern for anoxic brain injury, sequelae from notable infarcts on mri, or more favorably, lingering effects of sedating medications. patient continue to improve as far as short term memory and recall, with intermittent delusions which may have been due to his strokes and improving icu psychosis. patient was treated with zyprexa qhs and diazepam prn. . # f/u - patient will follow up with dr. / in clinic and with his pcp. is being d/c to acute rehab. medications on admission: warfarin diltiazem? no herbal supplements discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po bid (2 times a day): for one month. 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 5. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 6. coumadin 2 mg tablet sig: one (1) tablet po at bedtime. 7. warfarin 2 mg tablet sig: one (1) tablet po hs (at bedtime). 8. metoprolol succinate 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 9. lisinopril 5 mg tablet sig: three (3) tablet po daily (daily). 10. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 days. 11. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 12. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). 13. digoxin 125 mcg tablet sig: 0.5 tablet po once a day. discharge disposition: extended care facility: northeast - discharge diagnosis: st elevation myocardial infarction systolic heart dysfunction (ef 30%) acute in stent thrombosis discharge condition: stable. asymptomatic. discharge instructions: take all your medications as prescribed. followup instructions: echo in 4 weeks - 2pm in . . follow up with your cardiologist - dr. and dr. on @ 1pm in cardiology clinic. you will need signal averaged ekg and cardiac mri to be performed as an outpatient. you will also have an outpatient echo performed on at 2:00 pm prior to this appointment with dr. . . follow up with your pcp regarding liver nodule as mri was recommended to follow it. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization combined right and left heart cardiac catheterization coronary arteriography using two catheters coronary arteriography using two catheters injection or infusion of platelet inhibitor insertion of endotracheal tube enteral infusion of concentrated nutritional substances insertion of temporary transvenous pacemaker system arterial catheterization implant of pulsation balloon implant of pulsation balloon pulmonary artery wedge monitoring transfusion of packed cells cardiopulmonary resuscitation, not otherwise specified other irrigation of (naso-)gastric tube nonoperative removal of heart assist system injection or infusion of oxazolidinone class of antibiotics infusion of vasopressor agent cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: sciatica coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis unspecified essential hypertension acute myocardial infarction of other anterior wall, initial episode of care atrial fibrillation infection with microorganisms resistant to penicillins chronic kidney disease, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus cardiogenic shock other complications due to other cardiac device, implant, and graft methicillin susceptible pneumonia due to staphylococcus aureus acute systolic heart failure cardiac rhythm regulators causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to