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: a.c.e inhibitors / lidocaine / hydrocodone/acetaminophen / codeine attending: chief complaint: acute on chronic systolic heart failure shortness of breath bleed major surgical or invasive procedure: nasal packing by ent history of present illness: 75m with cad s/p cabgx2 and multiple caths, ef 35%, moderate as, ppm dm2, who presents with a history of shortness of breath due to acute on chronic systolic heart failure. cath at showed lmca had a distal 40% stenosis. the lad, ramus, and rca were proximally occluded. lcx had a patent stent. the lima-lad and svg-ramus were patent, and the svg- rca had a proximal 30%-40%. he presented to the ed yesterday with bleeding. he denies any chest pain or sob. . in ed, nasopharynx was . pt was hemodynamically stable. past medical history: -cad s/p cabg and stent placements in lmca and lcx -cabg , -type 2 diabetes mellitus -bilateral ten toe amputation following cholesterol emboli after cabg -hypertension -hypercholesterolemia -paroxysmal atrial fibrillation/flutter -aortic stenosis (valve area 0.8) -history of multiple strokes s/p bilateral carotid stents -peripheral arterial disease -gout -chronic kidney disease (baseline cr 1.4-1.9) -mild dementia -status post pacer implantation in for av conduction delay (2:1 conduction with ventricular rate of approximately 30) -chronic myositis with elevated ck -remote syncope with no inducible arrhythmias at ep study social history: social history is significant for the absence of current tobacco use, but smoked a pipe in past, quit 50 yrs ago. there is no history of alcohol abuse. there is no family history of premature coronary artery disease or sudden death. married. wife has . patient is primary caregiver. lives in in center. retired pilot and thermodynamics specialist. father died in 90's of unknown causes. mother died in 80's of liver cancer. family history: father died in 90's of unknown causes. mother died in 80's of liver cancer. physical exam: vs: t 98.5, 108/54, 85, 19, 92-98% 30% face tent gen: wdwn middle aged male in nad, resp or otherwise. mildly sleepy but awake, alert, conversational and appropriate heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with no jvd to angle of jaw cv: rr, normal s1, s2. systolic murmur lusb radiating to carotids. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. crackles at bases abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: trace le edema. 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 medical decision making pertinent results: 10:44pm ck(cpk)-119 10:44pm ck-mb-10 mb indx-8.4* ctropnt-0.03* 10:44pm hct-33.4* 03:05pm glucose-190* urea n-30* creat-2.0* sodium-138 potassium-4.3 chloride-100 total co2-25 anion gap-17 03:05pm estgfr-using this 03:05pm ck(cpk)-86 03:05pm ck-mb-5 ctropnt-0.03* 03:05pm wbc-10.1 rbc-3.54* hgb-10.8* hct-32.8* mcv-92 mch-30.5 mchc-32.9 rdw-14.2 03:05pm neuts-74.5* lymphs-16.4* monos-5.3 eos-2.9 basos-0.8 03:05pm plt count-542*# 03:05pm pt-25.0* ptt-32.8 inr(pt)-2.5* . . . 08:40am blood wbc-8.9 rbc-3.28* hgb-10.1* hct-30.1* mcv-92 mch-30.7 mchc-33.5 rdw-14.1 plt ct-488* 03:05pm blood neuts-74.5* lymphs-16.4* monos-5.3 eos-2.9 baso-0.8 08:40am blood plt ct-488* 08:40am blood pt-14.3* ptt-26.2 inr(pt)-1.3* 08:40am blood glucose-109* urean-15 creat-1.6* na-140 k-4.1 cl-106 hco3-25 angap-13 07:40am blood ck(cpk)-158 02:10pm blood ck(cpk)-172 04:11am blood alt-23 ast-29 ck(cpk)-173 alkphos-80 totbili-0.5 07:40am blood ck-mb-8 ctropnt-0.25* 02:10pm blood ck-mb-19* mb indx-11.0* ctropnt-0.34* probnp-5805* 04:11am blood ck-mb-18* mb indx-10.4* ctropnt-0.15* 10:44pm blood ck-mb-10 mb indx-8.4* ctropnt-0.03* 03:05pm blood ck-mb-5 ctropnt-0.03* 08:40am blood mg-2.3 04:11am blood calcium-8.2* phos-3.1 mg-2.0 . . pcxr : impression: small left pleural effusion. brief hospital course: 75m with cad s/p cabgx2 and multiple caths, ef 35%, moderate as, ppm dm2, who now presents with shortness of breath and tachycardia. diagnosed with acute on chronic systolic heart failure exacerbation with troponin leak. . 1. cardiac: a. coronaries: the patient had no chest pain symptoms, though was found to have elevated troponins in the setting of chf. the peak troponin was up to 0.35, peak ck 173, mb 18. these were noted to be trending dow. the mild enzyme elevation was likely attributable to chf vs demand ischemia. there is a history of cad s/p cabg x2. cath at revealed patent grafts. the patient was continued on aspirin, plavix, lipitor 80, beta blocker. . b. pump: the patient presented intially with chf and he was diuresed to euvolemic. there is a history of chf with ef 35%. he was continued on beta blocker and ace. . c. rhythm: there is a history of paroxysmal afib on coumadin. pacemaker was for for 2:1 av block . in the ed, the patient was noted to have a complex rhythm which showed pacer spikes. this was consistent with an svt with pacer tracking. there was initially concern in the ed for possible ventricular tachycardia though review of the ecg strip by cardiology confirmed that this was not the case. the ecg showed a sinus tachycardia with ventricular pacing. . d. valves: there is a history of aortic stenosis, 1.1 mean gradient 32 by cath at . the plan is for non-operative management per dr. since pt is a poor surgical candidate and has complex aortic atheroma . 2. epistaxis: there was heavy bleeding on presentation, enough to fill a cup or two per the patient. this was controlled with the nasal packing by ent. the packing was left in place until the day prior to discharge. coumadin was held initially. the plan for anticoagulation and antiplatelet therapy was discussed with the patient's outpatient cardiologist, dr. . dr. recommended continuing dual anti-platelet therapy given the concern for stent thrombosis, which the patient was assessed as high risk for this given his coronary anatomy. he had taxus stent in . the plan was to pursue a lower inr target for anticoagulation from 1.8 - 2.5, though this would be recalibrated to 2.0 - 3.0 as an outpatient if there was no further bleeding. . dm2: the patient was continued on insulin and sliding scale. . access: piv proph: anticoagulated, ppi medications on admission: protonix 40 daily asa 325 daily lasix 20 daily humulog 25u qac isordil 60 daily lantus 60u qhs lidex plavix 75 daily nitroglycerin 0.3 prn valsartan 80 daily lipitor 80 daily metoprolol 25 daily coumadin 10 daily senna colace prednisone clobetasol mupirocin 2% cream hydrocortisone 1% ointment calcipotriene 0.005% cream discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. clobetasol 0.05 % ointment sig: one (1) appl topical (2 times a day). 6. mupirocin calcium 2 % cream sig: one (1) appl topical daily (daily). 7. hydrocortisone 1 % ointment sig: one (1) appl topical daily (daily). 8. calcipotriene 0.005 % cream sig: one (1) appl topical (2 times a day). 9. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 10. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 11. insulin glargine 100 unit/ml solution sig: seventy (70) units qhs. 12. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 13. coumadin 2.5 mg tablet sig: four (4) tablet po once a day: please take a directed by coumadin clinic. new target inr per patient's cardiologist is 1.8 - 2.5. 14. outpatient lab work inr check thursday or friday discharge disposition: home with service facility: care tenders discharge diagnosis: primary diagnosis: epistaxis acute on chronic systolic chf exacerbation secondary diagnosis: coronary artery disease paroxysmal atrial fibrillation discharge condition: stable discharge instructions: you came to the hospital because you had a significant nosebleed. otolaryngology doctors the to stop the bleedingl. we stopped your coumadin medicine while you were in the hospital, although we are restarting this medicine now that you are being discharged. you should hold the valsartan for now because your blood pressure was running lower. this should be restarted by dr. when he sees you in clinic on if your blood pressure is improved. we recommend increasing the lantus dose from 60 units daily to 70 units daily. you should resume all of your other medications as previously including the coumadin. if you have further episodes of bleeding, if you have chest pain, shortness of breath, or any other concerning symptoms, please call your doctor or go to the emergency room. followup instructions: you have an appointment scheduled to see you primary care physician. , m.d. date/time: 10:00 please have an inr check on thursday or friday that should be followed up by the you have an appointment scheduled to see your cardiologist. provider , m.d. phone: date/time: 10:20 provider , : date/time: 11:15 procedure: control of epistaxis by posterior (and anterior) packing diagnoses: coronary atherosclerosis of native coronary artery diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation aortocoronary bypass status aortic valve disorders peripheral vascular disease, unspecified chronic kidney disease, unspecified other and unspecified hyperlipidemia other specified cardiac dysrhythmias other and unspecified angina pectoris other left bundle branch block long-term (current) use of anticoagulants cardiac pacemaker in situ anticoagulants causing adverse effects in therapeutic use other psoriasis urinary incontinence, unspecified epistaxis acute on chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to