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 and bare metal stenting. history of present illness: 53 m with h/o gerd and active tobacco use, initially presented to @ 20:30 with chest pain since noon. pain described as sharp, non-radiating. no associated sob, though has had nausea and some diaphoresis. . on arrival at , ecg initially showed sr @ 70 with qs inferiorly, unchanged from prior. however, laboratory studies revealed elevated cardiac biomarkers. received asa 325, lopressor 5 iv, heparin gtt, ntg gtt, and integrillin gtt. . at , pt continued to have pain on nitro gtt, iv fentanyl. also c/o nausea. taken to cath lab . of note, pt had been hospitalized at in with epigastric pain & vomiting at which time he was noted to have qs inferiorly on ecg and elevated total ck, but neg mb fractions and neg trop t. . on review of symptoms, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: arthritis gerd mild achalasia? by upper gi series in s/p excision of chest wall neuroma social history: social history is significant for current >1ppd tobacco use. there is no history of alcohol abuse or recreational drug use. he is employed as an electrician. family history: there is no family history of premature coronary artery disease or sudden death. father died of mi in his 60s. physical exam: vs: t 96.6, bp 121/83, hr 76, rr 11, o2 100% on 2l nc gen: middle aged male in nad, resp or otherwise. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with no jvd. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. abd: soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 2+ dp pertinent results: labs: 11:32pm blood wbc-16.9* rbc-4.66 hgb-14.4 hct-40.8 mcv-87 mch-31.0 mchc-35.4* rdw-13.3 plt ct-251 03:06am blood wbc-15.6* rbc-4.57 hgb-14.1 hct-39.6 mcv-87 mch-30.9 mchc-35.7* rdw-13.3 plt ct-271 05:18am blood wbc-11.5* rbc-4.26* hgb-13.1* hct-37.5* mcv-88 mch-30.7 mchc-35.0 rdw-13.3 plt ct-240 05:50am blood wbc-12.1* rbc-4.15* hgb-12.6* hct-37.5* mcv-90 mch-30.3 mchc-33.5 rdw-13.2 plt ct-227 06:00am blood wbc-9.1 rbc-4.07* hgb-12.5* hct-36.0* mcv-89 mch-30.6 mchc-34.6 rdw-13.3 plt ct-197 11:32pm blood pt-14.0* ptt-94.3* inr(pt)-1.2* 12:35pm blood pt-14.7* ptt-32.0 inr(pt)-1.3* 11:32pm blood glucose-127* urean-15 creat-1.1 na-137 k-4.9 cl-102 hco3-21* angap-19 03:06am blood glucose-126* urean-14 creat-1.1 na-132* k-5.9* cl-100 hco3-21* angap-17 05:18am blood glucose-118* urean-14 creat-1.1 na-140 k-4.3 cl-107 hco3-25 angap-12 06:00am blood glucose-97 urean-16 creat-1.1 na-141 k-3.7 cl-105 hco3-27 angap-13 11:32pm blood ck(cpk)-1704* 03:06am blood ck(cpk)-5100* 12:48pm blood ck(cpk)-4066* 09:00pm blood ck(cpk)-2587* 05:18am blood ck(cpk)-1480* 11:32pm blood ck-mb-244* mb indx-14.3* 11:32pm blood ctropnt-0.71* 03:06am blood ck-mb->500 ctropnt-7.38* 12:48pm blood ck-mb-366* mb indx-9.0* ctropnt-5.69* 09:00pm blood ck-mb-133* mb indx-5.1 ctropnt-4.21* 05:18am blood ck-mb-61* mb indx-4.1 09:57am blood %hba1c-5.6 03:06am blood triglyc-110 hdl-49 chol/hd-4.7 ldlcalc-157* . . studies: ecg at initially demonstrated sr @ 69 w/ qs inferiorly (ii, iii, avf) w/ <1mm ste iii & avf. qs v3-v6. . . cardiac cath performed on demonstrated: lmca: lad: mild diffuse up to 30% lcx: to om1 with r -> l collats to distal om rca: 99% mid pda with l -> r collats to distal vessel . om1 stented with bms x 2; unable to cross pda lesion. . . : the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is mild to moderate regional left ventricular systolic dysfunction with severe hypokinesis of the distal half of the inferior wall, distal septum, distal anterior wall and apex. the apex is not aneurysm and no thrombus is seen. the remaining segments contract normally (lvef = 35-40 %). transmitral and tissue doppler imaging suggests normal diastolic function, and a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the ascending aorta is moderately dilated. the aortic arch is mildly dilated. the aortic valve is functionally bicuspid with fused right and left raphe. the aortic valve leaflets are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with regional systolic dysfunction c/w cad. mild mitral regurgitation. dilated thoracic aorta. . . mri/mra chest: 1. 5.8-cm enhancing anterior mediastinal mass most suggestive of a low grade thymoma, but lymphoma is also a possibility. there is no evidence of vascular invasion. 2. mild fusiform aneurysmal dilatation of the ascending aorta to 4.5 cm. 3. fused left and right aortic cusps causing a functional bicuspid aortic valve. brief hospital course: 53 m presenting with inferior stemi s/p cath with placement of bms. . # cardiac - pt presented with symptoms, ekg changes and lab values consistent with inferior stemi (peak ck 5100). he was taken to the cath lab on hd#1 where he was found to have total occlusion of lcx with distal r->l collaterals, and 99% distal pda lesions. the om lesions was revascularized with bare metal stent, however unable to cross pda. pt was chest pain free after cath and had an uneventful hospital course. he was started on a cardiac regimen including aspirin, plavix, toprol xl, and lisinopril. he was discharged home on zocor insurance coverage. . post-mi tte was performed revealing severe hypokinesis of the distal half of the inferior wall, distal septum, distal anterior wall and apex. pt was therefore transitioned to coumadin with plan to continue therapy for at least 3 months, until repeat tte could be performed to evaluate akinesis or severe hypokinesis. he was discharged on lovenox 90mcg sc bid to be taken until inr is therapeutic. . his inr will be followed by his pcp , at which time he will begin being followed by the . this was arranged prior to his discharge and confirmed via phone conversation with his pcp () and - ac clinc (). he will continue lovenox for 2d after inr is between . . pt was aggresively counseled to discontinue smoking. he will follow-up with his new cardiologist, dr. , appt on . . # aortic dilation - tte also revealed moderately dilated aorta. mri/mra was then performed which confirmed mild fusiform aneurysmal dilatation of the ascending aorta to 4.5 cm. bp was well controlled on discharge (sbp 100s). pt was instructed to discuss a follow-up mri which will be obtained by his new cardiologist dr. in 6 months time, afterwhich he will likely need annual mri or ct scans to monitor his aortic dilation by either his pcp or cardiologist. . # mediastinal mass - on mri/mra obtained to better characterize aortic dilation, pt was incidentally noted to have a 5.8-cm enhancing anterior mediastinal mass most suggestive of a low grade thymoma. pt was informed of mass and instructed to f/u with thoracic surgery clinic in weeks. at that time he will need to discuss further workup re biopsy, and anticoagulation given that he is on asa, plavix, and coumadin. an appt could not be scheduled on day of discharge, so pt was provided with name of dr. pe?????? , and clinic phone number. . # gerd - pt d/c'd home on omeprazole as pantoprazole causes stomach upset. . # dispo - pt d/c'd home with instructions to f/u with pcp, cardiologist, and thoracic surgery. care was also established with . medications on admission: prilosec 20 ambien 5 prn discharge medications: 1. outpatient lab work please have your inr, pt, ptt checked on saturday . you should have the results faxed to your new cardiologist, dr. (tel), who will adjust your coumadin dose and instruct you as to when it is safe to discontinue your lovenox based on these results. 2. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*12* 4. warfarin 5 mg tablet sig: one (1) tablet po qdaily (). disp:*30 tablet(s)* refills:*2* 5. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 7. enoxaparin 100 mg/ml syringe sig: one (1) subcutaneous q12h (every 12 hours) for 7 days. disp:*14 * refills:*2* 8. simvastatin 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 10. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual prn chest pain: take 1 tablet sublingually for chest pain, may repeat three times, take 5 minutes apart, if still having chest pain, call 911. . disp:*25 * refills:*6* discharge disposition: home discharge diagnosis: st-elevation myocardial infarction hyperlipidemia congestive heart failure (ef 35-40%) with apical hypokinesis discharge condition: hemodynamically stable. ambulatory. discharge instructions: you were admitted with a heart attack. you were taken to the catheterization lab and a stent was placed to open up your artery. you will be taking several new medications that are very important: . you were started on lovenox (enoxaparin) an injected blood thinner which you should continue to take until your coumadin level is in the therapeutic range which is between 2 and 3. you should continue the lovenox injections for 2 days after your inr is between , or as instructed by your physician. have been given a 7d prescription with 2 refills. you will have your inr checked on as below, and then as instructed by dr. and the at -. . you have been started on coumadin to prevent blood clots in your heart and possible stroke. you will need to be followed by the , they will be calling you to arrange for follow-up starting . if you do not hear from them by you should call and ask about when your next labs should be drawn. . you have been started on aspirin and plavix to prevent blood clots in the stents in your coronary artery - it is very important, take every day and do not stop unless your cardiologist says this is okay). . you have been started on lisinopril and metoprolol (to help your heart to heal after a heart attack). . you have been started on atorvastatin (for cholesterol and to help your heart to heal after a heart attack). . you have been given a prescription for sublingual nitroglycerine (for any new chest pain), if you develop chest pain, you may take this medication up to 3 tablets, 5 minutes apart. if your pain has not resolved completely, you should call 911. you should report any chest pain you develop which improves with the nitroglycerin tablets to you cardiologist. . you should seek medical attention immediately if you develop chest pain, shortness of breath, nausea, fevers or any other concerning symptoms. followup instructions: you should follow-up with your primary care physician, . in 4 weeks. an appointment has been made for you on @ 1020am. we have spoken with him, and he will follow your inr values until when the at - will start following you. . you will need to have your inr checked on . you should go to your usual lab which you use with dr. . please have the results faxed to dr. at fax , tel . your goal inr is . dr. will adjust your coumadin dose and instruct you as to when you can discontinue your lovenox based on these values. you should continue your lovenox for 2d after your inr is between . . starting on you will have your inr values followed by the at -. we have informed them of your case, and you should receive a phone call from them by . if you do not, please call and ask about when your next inr should be checked. . you will need to follow-up with your new cardiolog, dr. , appointment has been made for you on @ 1pm, please call if you have any questions or concerns, his office is located at , , . he should order an mri of your aorta in 6 months as described below. . you were noted to have a mediasteinal mass on mri, you will need to follow-up with dr. . an appointment could not be made for you today, you should call ( to arrange for a follow-up appointment within the next 4-6 weeks to discuss your mediastinal mass. . you were noted to have moderate dilation of your aorta on mri during this admission, you will need a follow-up mri in 6 months to ensure that this has not changed. this should be ordered by dr., but can be ordered by dr. also. procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux tobacco use disorder congestive heart failure, unspecified thoracic aneurysm without mention of rupture systolic heart failure, unspecified other and unspecified hyperlipidemia acute myocardial infarction of inferoposterior wall, initial episode of care swelling, mass, or lump in chest 

Answer: The patient is high likely exposed to