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: dyspnea major surgical or invasive procedure: cardiac catheterization history of present illness: mr. is an 89 yo m with htn, hld, dmii, moderate as (valve area 1.0 cm^2) and ckd who presented with worsening chest pain, and admitted for elective cardiac cath. please see dr. admission note for full details. in brief, patient noted worsening exertional chest discomfort over the past few months, with decreased exercise tolerance (unable to walk ?????? mile without chest pain, and less resolution with rest). he had a tte with mildly depressed ef (50%) in , and an exercise stress test showing a mild, fixed inferior wall defect and global mild hypokinesis with a calculated left ventricular ejection fraction is 46 %. as a result of his symptoms and the above test results, he was admitted to on for pre-cath hydration prior to elective cardiac catherization. . in the cath lab today, patient received total fentanyl 82.5 mg iv and midazolam 2 mg iv. right and left heart cardiac catherization was performed. left heart cath revealed 2vd, with a heavily calcified lad 80% proximal, 90% serial mid, and 70% distal disease, lcx 40% proximal stenosis and a 60% stenosis of the ramus, and moderate aortic stenosis. right heart cath revealed both elevated left and right sided pressures. rotablade was performed on the lad (2 more proximal lesions followed by angioplasty). however, at that point, patient became confused, stated his back was hurting and tried to move off of the cath table despite requests to stay down, and contaminated the groin site with his hand. at that point, the cardiac catherization was stopped (no intervention on the distal lesion). he received 10 mg iv haldol total and 20 mg iv lasix, while in the cath lab. urine output unable to be measured due to condom cath being pulled off by patient. an angioseal was placed for arterial closure. he was started on integrillin and transferred to the ccu for closer monitering. . in the ccu, he continued to be confused, and attempted to sit up in bed despite having a venous sheath, and pull on his lines. he received an extra 5 mg of iv haldol and was placed in 4 point wrist restraints. he was able to follow most commands, but unable to answer any review of systems. past medical history: 1. cardiac risk factors: +diabetes, +dyslipidemia, +hypertension 2. cardiac history: -cabg: -percutaneous coronary interventions: -pacing/icd: 3. other past medical history: anemia chronic kidney disease (baseline cre 2.1) gout social history: patient was born in , moved to the us in . worked in construction as a labor foreman. married x 54 years, with 3 children and 9 grandchildren. denies tobacco or illicit drug use. occasional etoh use family history: no know fh of cardiac disease, diabetes, no colon/proste/breast cancer. parents lived to 70s to 80s with no known medical problems. children in good health. physical exam: vs: t= afebrile bp= 133/59 hr= 75% rr=15 o2 sat= 95% on ra general: agitated gentleman attempting to get out of bed and pulling at lines. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 6 cm. 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: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: aox1 ('', but unable to state location or date). unable to concentrate (cannot spell 'world' backwards). cn exam limited due to inability to follow most fine commands, but no gross deficiencies noted in . squeezes both hands on commands, dorsiflexes and plantar flexes feet on command. appropriate gross sensation and proprioception on both arms and legs. downgoing babinski bilaterally. 1+ symmetric reflexes in biceps and achilles tendons. unable to assess cerebellar function or gait due to wrist restraints. . pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ pertinent results: =================== admission labs: =================== 05:55am blood wbc-6.0 rbc-3.00* hgb-10.1* hct-29.9* mcv-100* mch-33.6* mchc-33.6 rdw-13.0 plt ct-224 05:55am blood pt-14.7* ptt-31.4 inr(pt)-1.3* 05:55am blood pt-14.7* ptt-31.4 inr(pt)-1.3* 05:55am blood glucose-77 urean-52* creat-2.3* na-138 k-5.2* cl-108 hco3-24 angap-11 05:30pm blood ck(cpk)-152 05:55am blood calcium-8.5 phos-3.4 mg-2.1 cholest-141 05:55am blood triglyc-111 hdl-27 chol/hd-5.2 ldlcalc-92 03:09pm urine color-yellow appear-clear sp -1.029 03:09pm urine blood-neg nitrite-neg protein-100 glucose-tr ketone-tr bilirub-neg urobiln-neg ph-5.0 leuks-neg 03:09pm urine rbc-2 wbc-<1 bacteri-none yeast-none epi-<1 transe-<1 03:09pm urine castgr-1* ==================== discharge labs: ==================== 05:20am blood wbc-7.4 rbc-2.77* hgb-9.2* hct-27.7* mcv-100* mch-33.2* mchc-33.2 rdw-12.9 plt ct-214 05:20am blood glucose-149* urean-75* creat-2.4* na-138 k-5.0 cl-106 hco3-23 angap-14 05:45am blood calcium-8.4 phos-4.9* mg-2.2 . ==================== imaging/procedures: ==================== cardiac cath : 1. coronary angiography in this left dominant system demonstrated two vessel disease. the lmca had no angiographically apparent disease. the lad was diffusely calcified with a proximal 80% stenosis, 90% mid stenosis, and 70% distal stenosis. the lcx had a 40% proximal stenosis and a 60% stenosis of the ramus. the rca was nondominant and had no angiographically apparent disease. 2. resting hemodynamics revealed elevated right and left sided filling pressures with rvedp 18mmhg and lvedp 21mmhg. there was moderate pulmonary arterial hypertension with pasp 61mmhg. the cardiac index was preserved at 2.33 l/min/m2. the svr was normal at 1300 dynes-sec/cm5. the systemic arterial blood pressure was normal with sbp 132mmhg and dbp 63mmhg. 3. there was moderate aortic stenosis with valve area of 1.0cm2 with mean gradient of 24.3mmhg. 4. successful rotational atherectomy (1.5mm burr) and ptca (2.5mm balloon) of the proximal and mid lad. 5. successful closure of the right femoral arteriotomy site with a 6f angioseal device. final diagnosis: 1. two vessel coronary artery disease. 2. serial lad stenoses. 3. moderate aortic stenosis. 4. successful atherectomy and ptca of the proximal and mid lad. . cxr :the heart size is moderately enlarged, similar compared to prior, and there are bilateral pleural effusions with volume loss in both lower lobes. there is pulmonary vascular re-distribution, but there is less perihilar haze compared to prior. there is volume loss/infiltrate in both lower lobes. impression: continued but slightly improved chf. brief hospital course: 89 yo m with multiple cad risk factors admitted for elective cardiac cath for symptoms of unstable angina and mild systolic dysfunction on tte, found to have 2 vessel disease(including severe lad disease) and moderate aortic stenosis. . # coronaries: the patient has multiple risk factors for cad including htn, hld, dm, ckd. he was directly admitted for cardiac catheterization because of a reversible defect seen on stress testing. cardiac catheterization showed 3 tight lad lesions and a 40% lcx stenosis. only 2 of 3 lad lesions were intervened on, when the patient became agitated and the procedure was terminated with the patient sent to the ccu for close monitoring. he received integrilin post-procedure, and was maintained on aspirin, plavix, high dose statin and metoprolol. additionally, he completed a three day course of cefazolin because of contamination of the groin site during the procedure secondary to the patient's agitation. . # delerium: peri-procedure, the patient exhibited symptoms of delerium including difficulty with concentration. the patient's neurologic exam was non-focal, and the ccu team felt the delerium was multifactorial in the setting of medication effect (benzodiazepines given peri-procedure), especially given ckd with decreased medication clearance, age and lack of sleep in the hospital prior to procedure. he received haldol with good effect and the delerium resolved completely prior to discharge. . # pump: at admission, the patient had no signs or symptoms of chf. however, he received prehydration with normal saline and bicarbonate infusions. during cardiac catheterisation, he was found to have elevated right and left sided pressures consistent with systolic and diastolic dysfunction. additionally, he was found to have moderate aortic stenosis (aortic valve area 1.0 cm^2, mean gradient 24 mm hg) with symptoms of in the as triad (angina, chf). he was diuresed with low dose iv lasix, with good effect. he was continued on metoprolol, and lisinopril held secondary to acute renal failure. . # rhythm: the patient remained in sinus rhythm throughout the hospital stay, with pr prolongation seen on ecg. he was continued on metoprolol. . # diabetes mellitus: the patient's oral hypoglycemics were held while in-house, and he was maintained on a regular insulin sliding scale. . # chronic kidney disease: patient with stage iv ckd, w/ cre clearance of 23. he received pre-cath hydration and iv mucomyst before and after catherization. his creatinine rose after cath to a peak of 2.9, and then began to decline. lisinopril was held for several days prior to hospitalization, and he was instructed to continue to hold this medication until being evaluated by his primary care physician. . # hyperkalemia: the patient's potassium was elevated to 5.9 in the ccu, likely secondary to acute on chronic renal failure after contrast load. he received kayexalate, insulin and d5 and had no ecg changes. his potassium remained stable thereafter. . # htn: lisinopril was held, and the patient continued on metoprolol. # deconditioning: the patient was evaluated by physical therapy prior to discharge, who recommended vna services with a home physical therapy regimen. . . medications on admission: lisinopril 40mg daily (on hold for past 2 days) glipizide 10mg daily actos 15mg daily asa 81mg daily discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. glipizide 10 mg tablet sig: one (1) tablet po once a day. 3. actos 15 mg tablet sig: one (1) tablet po once a day. 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: final diagnoses: coronary artery disease hypertension diabetes mellitus type 2 chronic kidney disease discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: you have a history of progressive chest dyscomfort with exertion and were admitted for a cardiac catheterization to evaluate for coronary artery disease. you were admitted the night prior to the procedure in order to give you intravenous hydration to protect your kidneys from the dye involved in the procedure. you underwent cardiac catheterization on , which showed narrowing of two of your coronary arteries. you became confused and agitated during the procedure, which we think was likely because of sedating medications. we made the following changes to your medications: - start plavix: this is a medication to help prevent blockages in your coronary arteries - start metoprolol: this medication treats your elevated blood pressure - start atorvastatin: this is a medication to treat your elevated cholesterol, and helps to prevent blockages in your coronary arteries - stop your lisinopril until you see your pcp at the end of the week. this medication was stopped prior to the catheterization to help protect your kidneys. your pcp may choose to restart this medication after checking your kidney function at your next visit. . we did not make any further changes to your home medications. please take all medications as prescribed. followup instructions: you have a follow-up appointment with your pcp , md on friday 1:15 pm. tel: provider: , m.d. phone: date/time: 1:20 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: hyperpotassemia anemia, unspecified coronary atherosclerosis of native coronary artery intermediate coronary syndrome congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortic valve disorders acute combined systolic and diastolic heart failure delirium due to conditions classified elsewhere 

Answer: The patient is high likely exposed to