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: percocet attending: chief complaint: chest pain with nstemi major surgical or invasive procedure: cardiac cath coronary bypass graft x 5 (left internal mammary artery to left anterior descending, saphenous vein graft to diagonal, saphenous vein graft to obtuse marginal, saphenous vein graft to posterior descending with y-graft to posterior lateral) history of present illness: 76 year old male s/p right total hip arthroplasty that developed atrial fibrillation and ruled in for and nstemi with troponin peak to 11, with post operative anemia (hct 27 dropped from 34.9) on post operative day two. he did develop chest pain but unable to describe and is now transferred to for cardiac workup including catheterization that revealed coronary artery disease and referred for surgical evaluation. past medical history: right hip fracture atrial fibrillation - new after arthroplasty prostate cancer - seed implants benign prostatic hypertrophy tobacco abuse past surgical history right hip fixation right total hip arthroplasty bilateral shoulder surgery appendectomy discectomy laminectomy and social history: race: caucasian last dental exam: edentulous lives with: spouse contact: phone # occupation: retired maintenance worker cigarettes: smoked no yes last cigarette - currenthx: 30 pack year history etoh: < 1 drink/week drinks/week >8 drinks/week illicit drug use denies family history: father died at age 82 of "old age" mother died at age 54 of stomach cancer. no known family h/o of cad, stroke, ckd in parents, sister, or grandparents. physical exam: pulse: 95 resp: 16 o2 sat: 93% b/p right: 112/76 left: 118/72 height: 183 cm weight: 73.9 kg general: no acute distress sitting up in bed skin: dry intact heent: perrla eomi neck: supple full rom chest: expiratory wheezes throughout no rhonchi heart: rrr irregular murmur none abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema none varicosities: spider veins bilateral lower extremities neuro: alert and oriented x3 non focal pulses: femoral right: +1 left: cath site dp right: +2 left: +2 pt : +2 left: +2 radial right: +2 left: +2 carotid bruit right: ? bruit left: no bruit right forearm with piv noted for phlebitis - warm red non tender pertinent results: cxr: pending cath: 1. coronary angiography in this right-dominant system demonstrated three-vessel and left main disease. the lmca had an ostial 80% stenosis. the lad was heavily calcified and had a 80% proximal stenosis. the lcx had moderate diffuse disease with an 80% stenosis in its first obtuse marginal branch. the rca was totally occluded and filled via collaterals. 2. resting hemodynamics revealed elevated right- and left-sided filling pressures, with an rvedp of 13 mm hg and a pcwp of 20 mm hg. there was moderate pulmonary arterial systolic hypertension, with a pasp of 49 mm hg. the cardiac index was preserved at 2.7 l/min/m2. the systemic arterial blood pressure was normal. there was no gradient upon pullback of the catheter from the left ventricle to the aorta. carotid u/s: there is less than 40% stenosis within the internal carotid arteries bilaterally. chest ct: 1. complete left upper lobe atelectasis with central obstructing lesion that potentially may represent obstructing tumor versus plaque and should be correlated with bronchoscopy. 2. multiple mediastinal lymph nodes, but none of them specifically enlarged. 3. right upper lobe and to a lesser extent right middle lobe opacity that most likely represent area of infection or aspiration and less likely asymmetric edema. 4. bilateral moderate pleural effusion. 5. extensive involvement of thoracic spine by multiple wedge compression fractures. old fracture of the right humerus. multiple rib fractures. echo: prebypass: the interatrial septum is aneurysmal. 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 mild inferior hypokinesis. overall left ventricular systolic function is mildly depressed (lvef= 45-50 %). the right ventricular cavity is mildly dilated with borderline normal free wall function. the ascending aorta is mildly dilated. the descending thoracic aorta is mildly dilated. there are complex (>4mm) atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. postbypass: lv systolic function remains unchanged. mr remains mild. study otherwise unchanged from prebypass. cxr: moderate-to-large left pleural effusion has increased since . generalized mediastinal widening, which developed between 7:30 a.m. and 10:45 a.m. on has changed in distribution but not in overall severity, concerning for mediastinal blood or other focal fluid accumulation. no pneumothorax. mild pulmonary edema and small right pleural effusion have increased. findings were discussed with the clinical care team member responsible for this patient, at the time of dictation. 09:40pm blood wbc-5.9 rbc-3.59* hgb-10.8* hct-31.5* mcv-88 mch-30.2 mchc-34.4 rdw-14.1 plt ct-199 08:05am blood wbc-6.1 rbc-3.54* hgb-10.2* hct-30.6* mcv-86 mch-28.9 mchc-33.5 rdw-13.5 plt ct-437 12:14pm blood wbc-8.1 rbc-2.69* hgb-8.1* hct-23.8* mcv-89 mch-30.2 mchc-34.2 rdw-13.7 plt ct-306 04:55am blood wbc-7.0 rbc-3.14* hgb-9.4* hct-27.1* mcv-86 mch-30.0 mchc-34.9 rdw-13.7 plt ct-353 09:40pm blood pt-13.2 ptt-42.0* inr(pt)-1.1 01:59am blood pt-16.6* ptt-35.0 inr(pt)-1.5* 08:30am blood pt-62.4* ptt-38.5* inr(pt)-6.9* 04:45am blood pt-33.8* ptt-39.9* inr(pt)-3.4* 04:55am blood pt-17.8* ptt-32.0 inr(pt)-1.6* 09:40pm blood glucose-166* urean-17 creat-0.7 na-136 k-3.9 cl-103 hco3-24 angap-13 04:45am blood glucose-105* urean-18 creat-0.6 na-137 k-4.5 cl-101 hco3-27 angap-14 04:55am blood glucose-130* urean-18 creat-0.7 na-139 k-4.6 cl-102 hco3-29 angap-13 09:40pm blood calcium-8.0* phos-2.5* mg-1.9 iron-14* 04:55am blood calcium-8.8 phos-3.7 mg-2.2 08:30am blood alt-14 ast-20 ld(ldh)-272* alkphos-68 amylase-17 totbili-0.8 07:30am blood %hba1c-5.6 eag-114 07:30am blood triglyc-66 hdl-28 chol/hd-4.0 ldlcalc-72 brief hospital course: mr. is a 76 year old gentleman status post total hip arthroplasty () at who presents with atrial fibrillation (hr 90-100)and post-op nstemi. he was found to have 3 vessel coronary disease demonstrated by catheterization () and is on day of empiric treatment for hospital acquired pneumonitis. cardiac surgery was consulted and he was worked-up in the usual manner for coronary artery bypass grafting. he was noted to have left forearm phlebitis. an ultrasound revealed no evidence of deep vein thrombosis. pulmonary function testing was obtained which showed an fev1 of 1.57l. a carotid duplex ultrasound was also obtained which showed less than 40% stenosis within the internal carotid arteries bilaterally. chest ct revealed new infiltrates and he developed a fever. cefepime and vancomycin were started and surgery was delayed. in addition there was complete left upper lobe atelectasis with central obstructing lesion that potentially may represent obstructing tumor. pulmonary was consulted and bronchoscopy was performed in the operating room at the end surgery. no official report but initial statement was mass seen in lul/bronchus. on , mr. was taken to the operating room where he underwent coronary artery bypass grafting to five vessels. please see operative note for details. following surgery he was transferred to the cvicu for invasive monitoring in stable condition. he remained intubated overnight and on post-op day one was weaned from sedation, awoke neurologically intact and extubated. chest x-ray prior to extubation showed lul open. chest tubes and epicardial pacing wires were removed per protocol. beta-blockers and diuretics were initiated and he was gently diuresed towards his pre-op weight. on post-op day two he was transferred to the step-down unit for further recovery. he required blood transfusion for anemia, hct 21 and had increase to 26. he also developed a brief episode of atrial fibrillation and was given amiodarone and beta-blockers. given his pre-op history, he was also started on coumadin. his inr quickly jumped to 6.3, coumadin was stopped and ffp was given. coumadin will continue on discharge given atrial fibrillation and recent right hip surgery (goal inr 2). he continued to make good progress while working with physical therapy for strength and mobility (decreased given recent hip surgery). on post-op day five he appeared to be doing well and was discharged to rehab with the appropriate medications and follow-up appointments. iv lasix will continue given 10+ kg above pre-op weight and moderate-large left pleural effusion. he has multiple appointments in the beginning of for further work-up of lung lesion. dr. has asked to wait for cardiology clearance prior to undergoing any procedure by pulm/thoracic. dr. will see him on and will most likely clear him if he is doing well. medications on admission: vancomycin 1 gram iv q12h atrovent 0.5 mg nebulizer inhaled q6h p.r.n. shortness of breath aspirin 325 mg by mouth daily celebrex 200 mg by mouth daily for four weeks dilaudid 2-4 mg by mouth every three hours as needed for pain flomax 0.4 mg by mouth daily lopressor 50 mg by mouth every eight hours lovenox 40 mg subcutaneous injection daily until last dose 7/10/2011multivitamin one tab by mouth daily nexium 40 mg by mouth daily senokot 2 tabs by mouth at bedtime tylenol 975 mg by mouth every six hours as needed for pain discharge medications: 1. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 6. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 7. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 8. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 10. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q2h (every 2 hours) as needed for wheezing and sob . 12. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 13. hydromorphone 2 mg tablet sig: one (1) tablet po q3h (every 3 hours) as needed for pain. disp:*40 tablet(s)* refills:*0* 14. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 15. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 16. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day). 17. amiodarone 200 mg tablet sig: two (2) tablet po daily (daily): please take 400mg daily for 7 days then decrease to 200mg daily until stopped by cardiologist. 18. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for groin . 19. coumadin 1 mg tablet sig: one (1) tablet po once a day: please titrate for goal inr of 2 for af and recent right hip surgery. inr 1.6. 20. furosemide 10 mg/ml solution sig: forty (40) mg injection q12h (every 12 hours): please switch to po once at pre-op weight of 73.9kg. 21. potassium chloride 10 meq tablet extended release sig: two (2) tablet extended release po q12h (every 12 hours). discharge disposition: extended care facility: tcu discharge diagnosis: coronary artery disease s/p coronary artery bypass graft x 5 myocardial infarction atrial fibrillation - new after arthroplasty left upper lobe pulmonary nodule past medical history: right hip fracture prostate cancer - seed implants benign prostatic hypertrophy tobacco abuse past surgical history s/p right hip fixation s/p right total hip arthroplasty s/p bilateral shoulder surgery s/p appendectomy s/p discectomy s/p laminectomy and discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with dilaudid/tylenol incisions: sternal - healing well, no erythema or drainage leg right/left - healing well, no erythema or drainage. edema trace discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. on at 1:00pm cardiologist: dr. at 12:30pm pulmonary: dr. on at 1:30pm in 9a thoracic: dr. on at 2:30pm in 9a ct of head with contrast on at 10:15am in 4 please call to schedule appointments with your primary care dr. in weeks to be scheduled by chest disease center: body pet/ct **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication: af/recent r hip arthroplasty goal inr 2 first draw, 1 day after discharge, procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures fiber-optic bronchoscopy (aorto)coronary bypass of four or more coronary arteries diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery tobacco use disorder unspecified pleural effusion acute posthemorrhagic anemia cardiac complications, not elsewhere classified atrial fibrillation pulmonary collapse other diseases of lung, not elsewhere classified surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation phlebitis and thrombophlebitis of superficial veins of upper extremities hip joint replacement 

Answer: The patient is high likely exposed to