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 cath on - stent to lad s/p intra-aortic balloon pump on - no complications history of present illness: 84 yo m c significant h/o cad, atrial fibrillation, s/p pacemaker placement for sick sinus transferred from osh for anterolateral stemi after elective total b/l knee replacements. pt recently had cardiac cath in for anginal symptoms resulting in pci with cypher stents placed in the left circumflex and lad. patient also had an mi approximately 10 years ago. bilateral total knee replacements performed at the osh without complications and with minimal blood loss. post op in the pacu, patient developed cp, diaphoresis, and sob. initial ekg at osh showed afib, prominent st elev in v2-v6, 1, and avl, and st depressions in inferior leads. patient was loaded on asa, plavix, heparin, integrillin, and tranferred to for catherization. asa and plavix had been discontinued one week prior to the procedure. catherization at showed 100% proximal stent restenosis, diffuse rca disease, and a patent left circumflex stent. a ptca was successfully placed in lad with restoration of timi 3 flow. the catherization was complicated by the development of wide complex tachycardia and hypotension (sbp 80s). as a result, the patient was defibrillated once, given iv lopressor, iv amiodarone, dopamine pressor, an intraaortic balloon pump, and intubated to protect airway. the patient als developed persistent distal lad spasm and treated with nitroglycerin ic and nipride. hemodynamics at time of catherization were: ra 18, pcwp 27, pa 53/30, co 3.16, ci 1.53. enzymes post catherization: cpk 4741, troponin 14.95. of note, persantine mibi showed small fixed inferior defect with slight atypical redistribution suggestive of ischemia. echo also done showed normal lvef of 60%, concentric lvh, and moderate mr. past medical history: cad -s/p pci to l circ and lad in -s/p mi years ago -: pmibi showed a small fixed inferior defect with slight apical redistribution suggestive of ischemia. -: echo showed normal lvef of 60%, concentric lvh, and moderate mr. atrial fibrillation on coumadin sick sinus syndrome, s/p pacer s/p bilateral total knee replacement s/p umbilical hernia repair social history: denies tobacco, etoh, italian speaking family history: no history of cad physical exam: gen- patient heavily sedated, intubated, unresponsive to auditory stimuli heent -intubated, perrl b/l neck - jvp elevated cv - rrr (initially not in afib), 2/6 systolic murmur heard best at apex, no gallops or rubs lungs - bibasilar cracklers right greater than left heard way up thorax abd - nabs, nontender/nondistended, soft extrem - 1+dp, 1+ pitting edema b/l pertinent results: 04:09am blood wbc-9.3 rbc-3.29* hgb-10.4* hct-30.0* mcv-91 mch-31.5 mchc-34.6 rdw-14.4 plt ct-144* 06:40pm blood wbc-9.5 rbc-2.79* hgb-8.4* hct-26.2* mcv-94 mch-30.2 mchc-32.2 rdw-13.5 plt ct-201 07:51am blood pt-13.1 ptt-52.1* inr(pt)-1.1 10:46pm blood plt ct-83* 09:05pm blood pt-14.4* ptt-53.3* inr(pt)-1.3 07:51am blood glucose-126* urean-41* creat-1.1 na-138 k-3.9 cl-101 hco3-30* angap-11 04:09am blood glucose-131* urean-35* creat-1.0 na-134 k-6.6* cl-99 hco3-28 angap-14 09:05pm blood glucose-232* urean-22* creat-1.0 na-139 k-4.2 cl-107 hco3-22 angap-14 07:00am blood ck(cpk)-1590* 10:46pm blood ld(ldh)-903* totbili-1.4 05:55am blood ld(ldh)-921* ck(cpk)-2419* 01:51pm blood ck(cpk)-4067* 09:05pm blood alt-67* ast-490* ck(cpk)-4741* alkphos-43 amylase-267* totbili-1.4 07:00am blood ck-mb-20* mb indx-1.3 02:56pm blood ck-mb-50* mb indx-2.1 ctropnt-7.41* 09:44pm blood ck-mb-50* mb indx-1.6 ctropnt-8.14* 04:03am blood ck-mb-205* mb indx-4.3 ctropnt-19.63* 09:05pm blood ck-mb-310* mb indx-6.5* ctropnt-14.95* 07:51am blood calcium-7.8* phos-2.5* mg-3.3* 09:05pm blood calcium-7.2* phos-2.9 mg-1.5* chest (portable ap) 8:23 am impression: bilateral effusions, otherwise no change since the prior chest x ray. ct abdomen w/o contrast 10:38 am indication: large st elevation with myocardial infarction. hematocrit drop. assess for retroperitoneal hemorrhage. ct of the abdomen without contrast: there are small bilateral pleural effusions and associated bibasilar atelectasis. there is a swan ganz catheter from a right femoral approach, along with an intra-aortic balloon pump. the balloon pump tip is not visualized. please corellate with chest radiographs for positioning. pacemaker leads, and an ng tube are present. evaluation of the abdominal organs is limited without iv contrast. there is no fluid adjacent to the liver or spleen. the gallbladder shows increased attenuation, likely from vicarious excretion of contrast from prior studies. the spleen, pancreas, adrenal glands, stomach, and bowel loops are all unremarkable. there is a low attenuation lesion in the upper pole of the left kidney which is not fully evaluated without iv contrast, and measures 2.7 x 2.8 cm. vascular calcifications are present in the aorta and splenic vessels. there is no evidence of retroperitoneal hemorrhage. ct of the pelvis without contrast: there is minimal stranding adjacent to both femoral arteries and veins, related to prior vascular punctures. note is made of a percutaneously placed line into the left femoral artery. this terminates in the common iliac artery. the bladder contains a foley catheter. there is no free fluid in the pelvis. extensive degenerative changes are seen throughout the spine. impression: 1. mild stranding about both femoral arteries in the groin, related to prior vascular access procedures. no significant hematoma. no evidence of retroperitoneal hemorrhage. 2. aortic balloon pump from right femoral artery. vascular catheter in left common femoral artery. 3. small pericardial effusion and bilateral pleural effusions. echo general comments: suboptimal image quality - poor subcostal views. resting tachycardia (hr>100bpm). based on aha endocarditis prophylaxis recommendations, the echo findings indicate a low risk (prophylaxis not recommended). clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. left pleural effusion. conclusions: the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. no left ventricular aneurysm is seen. there is severe regional left ventricular systolic dysfunction with hypokinesis of the basal septum and akinesis of the more distal septum and lateral wall and basal anterior wall. the more dital anterior wall and apex are mildly dyskinetic. no left ventricular thrombus is seen. right ventricular chamber size is normal with focal hypokinesis of the apical free wall. the aortic root and ascending aorta are mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. physiologic mitral regurgitation is seen (within normal limits). the pulmonary artery systolic pressure could not be estimated. there is a trivial/physiologic pericardial effusion. impression: extensive regional left ventricular systolic dysfunction and distal right ventricular hypokinesis c/w cad. cardiac cath: comments: 1. selective coronary angiography revealed a 100% proximal stenosis within the lad stent. the lmca was angiographically disease free. the lcx had a patent stent. the rca had moderate disease. 2. hemodynamics showed elevated right and left sided filling pressures with a mean ra pressure of 18mmhg, pcwp of 28mmhg. there was evidence of mild to moderate pulmonary htn with a pap of 53/30mmhg. the calculated cardiac index using an assumed o2 consumption was 1.53 lt/min/m2 consistent with severe cardiogenic shock. 3. successful ptca/stenting of the proximal lad with a 2.5x28mm cypher des. final angiography revealed residual stenosis throughout the course of the lad, timi-2 fast flow and no dissection. 3. wide complex tachycardia requiring 200 of biphasic electrical cardioversion. 4. profound cardiogenic shock requiring placement of a 8f/40cc iabp in the right femoral artery resulting in significant diastolic augmentation and systolic unloading. final diagnosis: 1. three vessel coronary artery disease. 2. elevated left and right sided filling pressures. 3. cardiogenic shock. 4. wide complex tachycardia. 5. atrial fibrillation. 6. pci of the lad. 7. pulmonary htn. 8. iabp placement. brief hospital course: brief hospital course by system: a. cardiovascular ischemia: patient had mi ten years ago and is s/p stent of left circumflex and lad . patient had elective bilateral total knee replacement, and asa and plavix had been discontinued one week prior to surgery. immediately post-op patient had chest pain and developed dynamic ekg changes suggestive of a large anterior stemi (confirmed by enzymes peaking at cpk of 4741 and troponin of 14.95). patient transferred to for catherization, which showed 100% proximal lesion in his lad stent, diffuse rca disease, and a patent left circumflex stent. a ptca was placed in lad with restoration of timi 3 flow. however, there was large componenent of distal lad spasm in the setting of pressors and ?embolization. it is felt that pt's stemi was secondary to acute stent thrombosis off aspirin and plavix. pt had massive ck leak and was found in cardiogenic shock necessitating dopamine and iabp from cath lab. during hospital course, pressors and balloon pump were gradually weaned. after hypotension resolved, pt was started on coreg and captopril. he will continue on aspirin, plavix indefinitely until otherwise instructed by dr. . meanwhile, his lipitor was increased to 80 mg. chf: pt admitted w/ anterior stemi complicated by cardiogenic shock. he was hypotensive in cath lab requiring maximum doses of dopamine and also trialed on dobutamine. an intra-aortic balloon pump was placed for additional support. echo during hospitalization showed ef of 20% with severe left ventricular systolic dysfunction. over hospital course, pt's pressors were weaned off and balloon pump was d/c'd on hospital day 4. with improved hemodynamics, pt was able to be diuresed approximately 2-3 liters and eventually weaned off oxygen requirements. coreg was started at low doses and also started on captopril which tolerated well. both bb and captopril should be titrated as hemodynamics tolerate in the next several weeks. meanwhile, he be anti-coagulated w/ coumadin given large apical wall akinesis. lovenox will be used as bridging therapy w/ goal inr 2.0 rhythm: history of chronic afib. during cath lab, initially found w/ wide complex tachycardia w/ compromised hemodynamics. was shocked x 1 w/ resolution of arrythmia. pt remained in afib for the majority of his hospital course and continued on anti-coaglation as above. at one point during hospital course, attempted dccv in attempt to improved hemodynamics w/ sinus rhythm. 3attempts at dccv failed and pt was decided to remain in afib. meanwhile, pt had frequent runs of nsvt during course. it was decided to place pt on amiodarone to suppress ventricular ectopy. amiodarone will be d/c'd at the discretion of his cardiologist, dr. . in addition, although pt already has pacemaker, dr. will decide on the utility of a defibrillator given his suppressed ef. b. ortho patient was followed by ortho throughout hospital course for bilateral total knee replacements. patient was able to get out of bed to chair on hospital day #6 under guidance by physical therapy. patient was also on given bilateral cpms on hospital day #7. ortho recommended discharging patient on long term anticoagulation to prevent dvts given knee replacement. he will need f/u w/ dr. in several weeks time. c. heme patient's hematocrit fell below 27 several times during hospitalization, likely secondary to bleeding within knees in the setting of anti-coagulation. to optimize hemodynamic status, patient was transfused a total of 8 u of prbc. addominal ct was performed was negative for retro-peritoneal bleed. d. respiratory initially intubated in the cath lab for cardiogenic shock. pt did well on ventilator and 1 day after balloon pump d/c'd, was easily extubated. his oxygen requirements have steadily been weaned during the remainder of hospital course. e. neuro patient's pain was initially managed with po vicodin. but initially, patient would spit up oral medications. as a result, patient was given iv morphine which resulted in a change in mental status. the patient was then given oxycodone, standing tylenol, and ultram for pain management. f. endocrine patient was put on an insulin drip post-cath to optimize glucose levels post acute-mi in icu setting. patient's glucose levels stabalized and were managed with sliding scale insulin. g. prophx patient was given senna/colace for constipation prophx, protonix for gi prophx, heparin for dvt prophx. h. dispo patient discharged to rehab in stable condition. patient had full code status throughout admission. medications on admission: digoxin 0.25mg qd aspirin 81mg qd lasix 40mg qd lipitor 20mg qd metoprolol 50mg plavix 75mg qd warfarin 5mg alternating with 7.5mg discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). 3. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day). 4. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 5. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 6. amiodarone hcl 200 mg tablet sig: two (2) tablet po bid (2 times a day). 7. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours). 8. tramadol hcl 50 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 9. atorvastatin calcium 40 mg tablet sig: two (2) tablet po daily (daily). 10. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day). 11. warfarin sodium 5 mg tablet sig: one (1) tablet po hs (at bedtime). 12. oxycodone hcl 5 mg tablet sig: 0.5-2.0 tablets po q4-6h (every 4 to 6 hours) as needed. 13. lovenox 80 mg/0.8 ml syringe sig: one (1) subcutaneous twice a day. 14. outpt meds please attempt to titrate coreg to 6.25 mg by mouth 2x/day over next week if hemodynamics remain stable. meanwhile, please continue to titrate lisinopril to 10 mg po qd in 1 week and then 20 mg by mouth qd in 2 weeks. 15. outpatient lab work please check inr on and - goal inr will be 2.0 to 3.0. please check hematocrit and electrolytes (na, k, bicarb, chloride, bun, creatinine on 16. lisinopril 5 mg tablet sig: one (1) tablet po once a day: may increase lisinopril to 10 qd in 1 week if sbp consistently greater than 100's. 17. lasix 80 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: anterior stemi s/p lad pci cardiogenic shock resolved respiratory failure resolved atrial fibrillation anemia s/p bilateral total knee replacements. discharge condition: stable discharge instructions: shortness of breath, palpitations, fevers, or chills please weigh pt daily and md if weight gain greater than 3lbs followup instructions: 1. please call dr. at for appt in weeks. 2. please call orthopaedist dr. for appt: ( in 2 weeks procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor other electric countershock of heart arterial catheterization implant of pulsation balloon transfusion of packed cells insertion of drug-eluting coronary artery stent(s) infusion of vasopressor agent diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute myocardial infarction of other anterior wall, initial episode of care cardiac complications, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases other and unspecified hyperlipidemia cardiogenic shock old myocardial infarction other complications due to other cardiac device, implant, and graft cardiac pacemaker in situ knee joint replacement aftercare following joint replacement 

Answer: The patient is high likely exposed to