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: cardiac catheterization, no interventions cardiac catheterization, drug eluding stent placed to left circumflex artery and left main coronary artery at takeoff of left circumflex history of present illness: 57 yom with history of 3vd s/p quintuple cabg in and redo cabg in and pci in of this year, htn, dm, and ckd on tu,, sunday transferred from osh ed for fever, sob and ekg changes concerning for ischemia. . brifely he was at his routine hd appointment yesterday and noted to have fever to 102. he endorses uri type symptoms for the last several days. hd center opted to forgoe dialysis and he was sent to osh ed for evaluation. en route he developed hypotension and sscp with radiation to his right arm. ekg on arrival to the osh ed showed.... std in v2-v6 as well as elevations in avr. there was some question of elevation in ii and iii. he was started on vancomycin, heparin, and nitro gtt and transferred to out of concern for acs. he was hypotensive en route and started on levophed. . on arrival to ed. pain free. off levophed, nitro. he reports his baseline sbp is in the 90's and falls as low as the 70's on hd. his levophed, and nitro gtt were dc'd. his cxr did not appear to be overly congested and he was lying flat with no hypoxemia. bedside echo did not show any wall motion abnormality. ed felt him to be somewhat dry and began to give him a 500 cc bolus. . labs were notable for an osh trop of 0.3, lactate of 1.2. enzymes ar pending. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: - cabg: - vfib arrest with cabg at for 3vd, 5vessel-cabg with lima to lad double touchdown with endarterectomy from d1 to apex; svg1 to om1 and jump to om2; and svg2 to pda - cabg redo sternotomy and coronary artery bypass graft x3, saphenous vein graft to obtuse marginal 1, 2 and 3. - percutaneous coronary interventions: pci poba to 70% l main occulsion, poba 90% in lad, des placed to l circ for 80% prox with 60% mid occlusion repeat cath showed instent restenosis of l circ (extending to l main) - pacing/icd: none 3. other past medical history: - esrd on hemodialysis (at quality care , tu,, overnight dialysis) - diabetes mellitus with renal complications - neuropathy - retinopathy -obstructive sleep apnea (previously on cpap, now resolved after weight loss) - cataract - charcot foot due to diabetes mellitus - hypothyroidism - hyperlipidemia - obesity s/p lap band () - hyperparathyroidism renal - renal osteodystrophy - pulmonary nodule (solitary) - history of colonic adenoma - left arm fistula - s/p lap band () social history: lives in with his wife and sister-in-law. 3 children who live in the area. retired 3 years ago. since cabg, has been back to his baseline after (except lifting), but he is not very active at baseline. tobacco history: 30 pack year history, quit at time of cabg in . etoh: never illicit drugs: denies family history: father with kidney disease. no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death. uncle with cancer, nos. physical exam: physical exam on admission vs: 104/65 p96 98% o2 on 2l nc 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. neck: supple with no jvp 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: slightly decreased breathsounds at the bilateral bases. no crackles or edema. abdomen: soft, ntnd +bs neuro: aaox3 pulses: right: dp 2+ left: dp 2+ physical exam on discharge: afebrile, bp 90s-110s/60s exam unchanged pertinent results: admission labs: 08:50am blood wbc-9.0# rbc-3.66* hgb-11.8* hct-35.6* mcv-97 mch-32.2* mchc-33.1 rdw-16.3* plt ct-160 08:50am blood neuts-90.2* lymphs-5.2* monos-3.0 eos-0.4 baso-1.1 08:50am blood pt-12.9* ptt-54.9* inr(pt)-1.2* 08:50am blood glucose-176* urean-66* creat-12.7*# na-136 k-6.0* cl-98 hco3-21* angap-23* 08:50am blood calcium-7.7* phos-5.1* mg-2.6 cardiac enzymes: 08:50am blood ck-mb-21* mb indx-5.8 08:50am blood ctropnt-1.60* 03:00pm blood ck-mb-23* mb indx-5.1 ctropnt-3.71* 11:12pm blood ck-mb-11* ctropnt-5.66* 04:23am blood ck-mb-4 09:11am blood ck-mb-4 ctropnt-3.31* discharge labs: 05:49am blood wbc-5.1 rbc-3.30* hgb-10.3* hct-32.5* mcv-99* mch-31.2 mchc-31.6 rdw-16.0* plt ct-148* 05:49am blood pt-11.2 ptt-31.7 inr(pt)-1.0 05:49am blood glucose-63* urean-36* creat-8.5*# na-140 k-4.4 cl-100 hco3-29 angap-15 09:11am blood alt-35 ast-55* ck(cpk)-134 alkphos-51 totbili-0.4 09:11am blood lipase-43 05:49am blood calcium-7.6* phos-4.4 mg-2.4 03:00pm blood tsh-0.13* microbiology: blood culture x 4 negative cdiff stool negative reports: radiology chest (portable ap) the lungs are clear. there is no focal consolidation to suggest pneumonia. heart size is enlarged, but unchanged. bibasilar opacities represent atelectasis in the setting of low lung volumes. sternotomy wires and cabg clips are noted. there is no pneumothorax. no definite pleural effusions are seen echo: this study was compared to the prior study of . right atrium/interatrial septum: mildly dilated ra. normal interatrial septum. no asd by 2d or color doppler. left ventricle: normal lv wall thickness. normal lv cavity size. mild regional lv systolic dysfunction. no lv mass/thrombus. no resting lvot gradient. no vsd. right ventricle: mildly dilated rv cavity. mild global rv free wall hypokinesis. aorta: mildly dilated ascending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. no ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. mild thickening of mitral valve chordae. no ms. mild to moderate (+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. no ts. mild tr. borderline pa systolic hypertension. pulmonic valve/pulmonary artery: no ps. pericardium: very small pericardial effusion. no echocardiographic signs of tamponade. conclusions no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with inferior, infero-lateral, distal lv/apical hypokinesis suggested. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the ascending aorta is 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 mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is borderline pulmonary artery systolic hypertension. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , no change. cardiac cath; 1. selective coronary angiography of this co dominant system revealed three vessel native coronary artery disease. the lmca had a 90% distal instent restenosis. the lad had 50% ostial disease and 95% stenosis after d1. d1 was 100% occluded. the lcx had 99% proximal instent restenosis. the mid lcx had 80% stenosis and the om1 was 100% occluded. the rca was 100% totally occluded proximally. 2. limited resting hemodynamics revealed borderline low systemic blood pressure of 80/50 mmhg that is close to patient's baseline. gentle ivf were given since hd performed earlier that day. 3. saphenous vein graft arteriography showed the svg-rca to be widely patent. the svg-om1 had mild irregularity only and the proximal stent was widely patent. there was 60% diffuse disease in the om1 proximal and distal to touchdown site. the jump segments of this graft to om2 and om3 (l. lpl) are flush occluded (similar to prior angiography 5/). there is a jump segment (from first bypass surgery) from om1 to om2 which is widely patent. 4. arterial conduit angiography was deferred as lima-lad known patent and competative flow seen in distal native lad. final diagnosis: 1. three vessel coronary artery disease. 2. patent svg-rca, patent svg-om1 with occluded jump segment. 3. patent proximal svg-om1 stent. 4. borderline low blood pressure. 5. demand ischemia likely due to limited flow through jump segment from om1-om2 with intervening disease between anastamosis sites. 6. medical management, however if ongoing ischemia or chest pain, would consider pci of native lmca-lcx to improve perfusion to distal codominant lcx system. cardiac cath 1. selective coronary angiography in this right dominant system demonstrated an 80% distal lmca stenosis, a 99% ostial cx stenosis (both in-stent restenosis) and a seperate 80% stenosis in the mid cx. 2. selective arterial conduit angiography revealed a widely patent lima to lad/d1. there is an occlusion of the distal lad beyonf the touchdown of the lima. 3. limited resting hemodynamics revealed a central aortic pressure of 89/54 mmhg. 4. successful ptca and stenting of the mid cx with a 3.0x16mm promus element stent which was postdilated to 3.25mm. final angiography revealed no residual stenosis, no angiographically apparent dissection and timi iii flow (see ptca comments). 5. ptca and stenting of the lmca and proximal cx with a 3.5x24mm promus element stent which was postdilated proximally to 4.5mm and distally to 4.0mm. final angiography revealed no residual stenosis, no angiographically apparent dissection and timi iii flow (see ptca comments). final diagnosis: 1. three vessel coronary artery disease. 2. successful ptca and stenting of the mid cx with a des. 3. successful ptca and stenting of the lmca and proximal cx with a des. brief hospital course: mr. is a 57 year old male with history of diabetes, hypertension, and coronary artery disease (cad) status post cabg x 2 with 8 total bypasses as well as recent pci 2 weeks prior to admission who was transferred from osh with chest pain and dynamic ekg changes in the setting of fever, hyperkalemia and hypotension. he was admitted to the ccu for dialysis and cardiac catheterization and recieved 2 drug eluding stents (des) to his left circumflex and left main coronary arteries. # coronary artery disease (cad): patient with extensive known cad. patient was started on heparin drip at osh and this was continued on admission. he was also continued on atorvastatin 80 mg daily, asa 325 mg daily, clopidogrel 75 mg daily and metoprolol 12.5mg . notably, he is not on an acei. he underwent cardiac catheterization on which showed 3 vessel disease but he was not stented at this time because it was felt that st changes at osh could represent acute coronary syndrome vs demand ischemia from fever, hypotension and tachycardia. he continued to have chest pain however, so he returned to the cath lab on and had 2 des placed. one in his left circumflex and one in his left main, these jailed the lad--it is now only supplied by the lima graft. after the stents were placed, he had resolution of his chest pain. his medications were not changed except aspirin was decreased to 81 mg daily. # chronic systolic heart failure (schf): patient was not grossly volume overloaded on admission with no edema on cxr or exam. last known ef of 45% in of this year. fluid status is managed with hemodialysis as patient does not make urine. recieved hd while he was an inpatient, continued on metoprolol 12.5 mg , no diuretics or acei given the renal impairment. # fever: patient presented with fever at dialysis and osh after developing sore throat and cough. his family had similar symptoms raising concern for viral upper respiratory infection. however, he was started on empiric vancomycin and zosyn at osh for presumed healthcare assoc pneumonia (hcap). zosyn was transitioned to cefepime on transfer. cxr showed no evidence of pneumonia and cultures grew nothing for 48 hours, cdiff negative. thus, all antibiotics were discontinued and he did not have any additional fevers. chronic problems: # stage renal disease (esrd): patient presented with mild volume overload and hyperkalemia in setting of missed hemodialysis (hd). he underwent urgent dialysis morning of admission and was then continued on intermittent hd. he continued his sevalamer with meals and nephrocaps daily. # diabetes mellitus, type 2 (dmt2): continued home regimen of long acting insulin 10 units qam and 20 units qpm with sliding scale coverage. # hyperlipidemia (hld): continued atorvastatin 80 mg daily. # hypothyroidism: continued thyroxine 300 mcg 5x/week. tsh was 0.13. transitional issues: - tsh was low, his levothyroxine dose should be discussed with pcp dialysis - consider adding acei for heart failure benefit even though he has renal failure because this will not damage the kidneys further medications on admission: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. insulin aspart 100 unit/ml insulin pen sig: per sliding scale subcutaneous three times a day. 6. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po q8h (every 8 hours) as needed for constipation. 7. levothyroxine 100 mcg tablet sig: three (3) tablet po 5x/week (mo,tu,we,th,fr). 8. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 9. sevelamer carbonate 2.4 gram powder in packet sig: two (2) packets po tid (3 times a day). 10. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. nph insulin human recomb 100 unit/ml suspension sig: as directed units subcutaneous as directed: 10 units qam, 20-30 units qpm. discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. insulin nph & regular human 100 unit/ml (70-30) suspension sig: as directed units subcutaneous twice a day: 10 units at breakfast, 20 units at bedtime. 6. insulin lispro 100 unit/ml insulin pen sig: as directed units subcutaneous three times a day: per sliding scale. 7. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 8. levothyroxine 100 mcg tablet sig: three (3) tablet po 5x/week (mo,tu,we,th,fr). 9. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 10. sevelamer carbonate 2.4 gram powder in packet sig: two (2) packets po three times a day: with meals. 11. aspirin 81 mg tablet, effervescent sig: one (1) tablet, effervescent po once a day. discharge disposition: home discharge diagnosis: primary diagnosis coronary artery disease viral upper respiratory infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to the hospital because you had some chest pain while you had fevers. your fevers were from a viral upper respiratory infection and you were already getting better from that. you underwent a cardiac cath which showed that your chest pain likely came from some blockages to blood flow. you had stents put in the arteries of your heart to open them up and we expect your chest pain to be resolved. medication changes made: we decreased your aspirin to a baby aspirin (81mg a day). you should keep all of the follow-up appointments listed below. bring your medications to each appointment so your doctors update their records and adjust doses as needed. it was a pleasure taking care of you in the hospital! followup instructions: name: ,md specialty: priamry care location: - address: 111 dr, , phone: when: , at 10:00am name: , md specialty: cardiology location: address: 111 dr, , phone: when: , a 11:00am department: hemodialysis when: saturday at 7:30 am procedure: coronary arteriography using two catheters coronary arteriography using two catheters left heart cardiac catheterization left heart cardiac catheterization hemodialysis arteriography of other specified sites insertion of drug-eluting coronary artery stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] destruction of cranial and peripheral nerves procedure on three vessels diagnoses: hyperpotassemia end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere renal dialysis status subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension unspecified acquired hypothyroidism aortocoronary bypass status diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes peripheral vascular disease, unspecified unspecified viral infection long-term (current) use of insulin chronic systolic heart failure other complications due to other cardiac device, implant, and graft secondary hyperparathyroidism (of renal origin) other postprocedural status surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy unspecified cataract chronic total occlusion of coronary artery acute upper respiratory infections of unspecified site renal osteodystrophy 

Answer: The patient is high likely exposed to