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 with placement of bare mental stents x 4 history of present illness: 60 yo male with history of gout, hld, htn, anemia of chronic inflammation presents with substernal chest pain. . patient notes that over the last several days he has had intermittent chest discomfort when at work. he notes that the pain would go away if he stopped relaxed and took a deep breath. the day of presentation the patient developed substernal chest pain without radiation which was associated with palpitations, diaphoresis, shortness of breath. his brother gave him 4 baby aspirins which he chewed and called 911. in the ambulance the patient recieved nitroglycerin without improvement in his chest pain. . in the ed, initial vitals 80 160/80 16 98% 2l. ekg concerning for inferior with a. fib with . code called. patient started on heparin gtt, morphine 4 mg iv, diltiazem 50mg iv x one, plavix 300mg. . in the cath lab, catheterization revealed a 90% mid rca lesions. other vessels without significant disease. case complicated by rca dissection, at one point vessel was lost, entire vessel ballooned with four bare metal stents. patient transiently on dopamine for borderline hypotension. patient in a. fib with and given lopressor 17.5 mg iv total iv. one unit of blood given for hct of 24.9 . bivalrudin given during case given history of iron deficiency anemai. angioseal placed. . in the ccu, patient remains in afib with with stable blood pressure. he reports no chest pain. . on review of systems, 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. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, syncope or presyncope. past medical history: 1. cardiac risk factors: hypertension, hyperlipidemia 2. cardiac history: none 3. other past medical history: - gout - anemia: admission in with hct of 15 without clear etiology 7 units of prbcs transfused. hemolysis labs negative. stool guaiac negative. bone marrow biopsy with heme/onc negative. last colonoscopy 10 years ago. social history: he is unmarried and has no children. he lives with his brother in . he is currently unemployed, but works odd jobs when he can, usually construction. he has a 42 pack year history. he drinks 4-6 beers a week. he denies use of illicits. family history: hypertension - mother (died at 92) father - unknown medical history, died of unknown causes physical exam: on admission: vs: afebrile bp=114/86 hr=150 rr=15 o2 sat= 100% 2l general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. poor dentition. neck: supple with jvp at base of neck. cardiac: irregular, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: unable to examine posterior lung field as patient post cath. anterior lung field with coarse breath sounds. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: radial 2+ dp 2+ pt 2+ left: radial 2+ dp 2+ pt 2+ on discharge: temp max:101.9 temp current: 99.1 hr:67-83 rr:18 bp:139-183/87-98 o2 sat: 100% ra gen: nad, sitting comfortably in chair cv: rrr, systolic murmur rusb resp: ctab, no rales or wheezes, unlabored abd: s/nt/nd, +bs extr: no peripheral edema, r knee edematous, blottable, no erythema or warmth neuro: a/o, no focal deficits pertinent results: cbc wbc rbc hgb hct mcv mch mchc rdw plt ct 06:50 9.4 4.15* 11.7* 35.5* 86 28.2 33.0 17.1* 242 23:00 30.9* 15:00 32.5* 06:30 10.0 3.77* 10.8 32.3* 86 28.7 33.4 17.3* 223 21:20 30.1* 13:15 29.1* 04:55 8.5 3.01* 8.6* 25.7* 86 28.7 33.5 17.3* 232 21:45 9.8 2.87* 7.9* 24.9*1 87 27.6 31.8 18.0* 273 renal & glucose glucose urean creat na k cl hco3 angap 06:50 109*1 16 0.9 139 4.7 102 26 16 06:30 961 15 0.9 138 4.7 105 24 14 04:55 108*1 23* 0.8 141 4.7 111* 19* 16 21:45 111*1 27* 0.9 142 3.4 106 18* 21* cpk isoenzymes ck-mb ctropnt 13:15 27* 04:55 38* 21:45 0.02* hematologic hapto 04:55 253* studies/procedures - ecg: afib with approx 160, normal axis. st elevation in iii with depresssions v3-v6. right sided leads with 1mm st elevation v4-v6. . - cardiac cath: per report. 90% occlusion of mid rca. case complicated by dissection with near loss of vessel. vessel balloned and 4 bms placed with resolution of flow. final report pending at time of discharge. . - tte: the left atrium is elongated. the right atrium is moderately dilated. 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 hypokinesis to akinesis. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size is normal. with borderline normal free wall function. the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the prior study (images reviewed) of , regional lv systolic dysfunction is new. the aortic valve area is similar despite lower gradients due to decreased stroke volume. brief hospital course: 60 yo male with hld, htn, gout, anemia who presents with cp found to have inferior s/p cardiac catheterization complicated by rca dissection necessitating placement of bms x 4. active issues: # - pt presented with cp and was found to have inferior on ekg. in the cath lab, catheterization revealed a 90% mid rca lesions. other vessels without significant disease. case complicated by rca dissection, entire vessel ballooned with four bare metal stents. patient transiently on dopamine for borderline hypotension. one unit of blood given for hct of 24.9. bivalrudin given during case given history of iron deficiency anemia. pt started on clopidogrel 75 mg po daily, simvastatin 40mg, metoprolol xl 150 po daily, and losartan 50 mg po daily. echo revealed mild regional left ventricular systolic dysfunction with inferior hypokinesis to akinesis. he was initially started on aspirin 325mg, however this was decreased to 81mg po daily given concern for possible gi bleed. this should be re-evaluated as an out-patient with pcp and gi. patient will follow up with cardiology on . . #afib with - pt was in afib with in cath lab and ccu so given lopressor 17.5 mg iv total during cardiac catheterization. in the ccu, started on esmolol gtt. blood pressures remained stable. pt returned to sinus rhythm, esmolol gtt d/c'ed , remained in sinus for remainder of hospitalization. . #normocytic anemia - hct at 24.9 following catheterization, down from baseline in low 30s. pt responded well to 3 units prbc. ongoing outpt work up of anemia without clear etiology. hemolysis labs negative. gi was consulted given hct drop in setting of dark stools while on plavix and aspirin. given recent , stablization of hct, and normalization of stools, egd was deferred at this time. pt needs to follow-up with gi in 6 weeks for egd and colonoscopy for continued work-up of anemia. he was started on pantoprazole 40mg po bid. he should continue plavix 75mg po daily, however aspirin was decreased from 325mg to 81mg pending further work-up because of increased risk of bleeding. chronic issues: #gout - pt complained of gouty r knee pain, so started on colchicine in addition to his home allopurinol. he was not started on prednisone given the risk of gi bleeding. his pain was well managed with oxydocone 5mg po prn. . #htn - increased blood pressure managment with metoprolol xl 150 po daily, losartan 50mg po. his blood pressure improved to 130's/80s so will need close monitoring and medication adjustment by pcp. . #hl - increased simvastatin to 40mg po daily in setting of recent . transitional issues: full code. blood cultures and urine cultures were sent given low grade fever and are still pending at time of discharge. pt is being discharged home with many new medications and medication changes. these changes were discussed with the patient in detail. he has several follow-up appointments in the next few weeks including pcp (), cardiology (), endocrine and hem/onc(). he will need a referral from his pcp to see gi for egd and colonoscopy. medications on admission: --metoprolol 50mg --simvastatin 20mg daily --cyclobenzaprine 10mg tid --tramadol 50 q6hrs prn pain --prednisone 10mg prn gout flair --asa 325mg daily --allopurinol 200mg daily --losartan 25mg daily discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. simvastatin 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. losartan 50 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 6. colchicine 0.6 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 7. oxycodone 5 mg tablet sig: one (1) tablet po twice a day as needed for knee pain for 2 days: do not take this medication and drive or consume alcohol. disp:*4 tablet(s)* refills:*0* 8. metoprolol succinate 100 mg tablet extended release 24 hr sig: 1.5 tablet extended release 24 hrs po once a day. disp:*45 tablet extended release 24 hr(s)* refills:*2* 9. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*30 patch 24 hr(s)* refills:*2* 10. allopurinol 100 mg tablet sig: two (2) tablet po once a day. 11. cyclobenzaprine 10 mg tablet sig: one (1) tablet po three times a day. 12. tramadol 50 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. discharge disposition: home discharge diagnosis: primary diagnoses: inferior atrial fibrillation with hypertension gout anemia requiring blood transfusion discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you at . you were admitted for chest pain. you were found to be in atrial fibrillation and were diagnosed with a heart attack. we treated your heart attack by placing 4 stents in the arteries to keep the blood flowing. your heart rate returned to during your hospitalization. take all your home medications as directed except for the following medication changes or additions that were made during your hospital stay: 1. increase the dose of losartan to 50 mg by mouth daily. 2. increase simvastatin to 40mg by mouth daily. 3. start taking clopidogrel 75mg by mouth daily. do not stop taking this medication unless instructed by your cardiologist. 4. stop taking aspirin 325 mg and instead take aspirin 81mg until gi follow-up. you must take this medication daily unless instructed otherwise by your cardiologist. 5. change metoprolol to metoprolol xl 150mg by mouth daily. 6. start taking pantoprazole 40mg by mouth twice a day until gi follow-up. 7. start taking colchicine 0.6 mg by mouth twice a day until gout flare resolves. 8. stop prednisone until gi follow-up because of increased risk of bleeding. followup instructions: department: cardiac services when: tuesday at 10:30 am with: , md building: campus: east best parking: garage department: div of gi and endocrine when: wednesday at 1:40 pm with: , md building: ra (/ complex) campus: east best parking: main garage department: hematology/oncology when: wednesday at 4:00 pm with: , md building: sc clinical ctr campus: east best parking: garage name: , location: , , phone: appt: friday, at 1pm note: it is recommended that you have an egd and colonoscopy within the next 6 weeks. please work with dr for help coordinating these procedures. procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: anemia of other chronic disease coronary atherosclerosis of native coronary artery tobacco use disorder unspecified essential hypertension gout, unspecified occlusion and stenosis of carotid artery without mention of cerebral infarction other and unspecified hyperlipidemia acute myocardial infarction of other inferior wall, initial episode of care 

Answer: The patient is high likely exposed to