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: pre-cath hydration major surgical or invasive procedure: cartotid angiogram history of present illness: 71 yo f with history of cad, severe pvd, dm, htn who presents for pre-cath hydration prior to carotid angiogram. patient has a history of severe pvd with recent admission for pci on l deep femoral artery. recent u/s of carotids shows 50-79% right ica and 70-79% left ica stenosis. here for evaluation and possible stenting by dr. and dr. . she denies any history of stroke and has never had any episodes of focal weakness, numbness, loss of vision, speech difficulties or any other tia symptoms. she has had only one brief episode of chest pain since her prior admission which was non-exertional and lasted a few minutes, alleviated with one sl nitro. she cannot remember other details about the cp. she is able to walk multiple blocks without chest pain or shortness of breath. she denies orthopnea, pnd, n/v, diaphoresis, le edema, or syncope. she does note a mild dry cough over the last few days. no associated congestion or shortness of breath, no recent fevers or chills. on further ros she also notes mild occasional occipital ha, relieved by tylenol and baseline pain in upper thighs at rest pvd and worse in le with exertion. she also notes increased fatigue over the last few weeks but denies any palpitations, lightheadedness or syncope. past medical history: cad - s/p 3 mis, did not experience chest pain at the time. she has a known occluded rca chf- ef 20-25%, ischemic cardiomyopathy, s/p icd placement in for primary prevention. has only discharged once 2 years ago pvd - has symptoms of claudication s/p poba to l profunda femoral artery, known 99% r sfa and 100% l sfa occulusions small aaa hypothyroidism dm htn hld copd asthma history of bladder ca - had tumor excision without chemo or radiation carotid stenosis: 50-79% right ica and 70-79% left ica stenosis on u/s . surgical history appendectomy hysterectomy . social history: quit smoking 4 years ago, s/p year pack history, no etoh use. family history: strong family history of cad, in brothers, sister, father and mother physical exam: vs - t: 98.2 p: 64 bp: 141/58 rr: 18 o2: 100% ra gen: wdwn middle aged female in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp not elevated. possible bruit on r carotid cv: pmi located in 5th intercostal space, midclavicular line. irregular rhythm, normal s1, s2. no m/r/g appreciated. no thrills, lifts. ? s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, very mild bibasilar crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 0+ dp 0+ pt 0+ left: carotid 0+ femoral 2+ popliteal 0+ dp 0+ pt 0+ pertinent results: 05:17pm blood wbc-8.1 rbc-3.87* hgb-11.2* hct-31.9* mcv-83 mch-29.0 mchc-35.1* rdw-13.9 plt ct-233 05:17pm blood glucose-280* urean-40* creat-1.8* na-134 k-3.9 cl-93* hco3-30 angap-15 06:05am blood glucose-280* urean-46* creat-1.8* na-139 k-5.0 cl-99 hco3-32 angap-13 06:05am blood ck(cpk)-93 05:40am blood ck-mb-notdone ctropnt-0.03* 05:17pm blood calcium-9.8 phos-3.2 mg-2.3 05:40am blood %hba1c-10.1* 05:40am blood triglyc-582* hdl-30 chol/hd-5.9 ldlmeas-70 05:17pm blood digoxin-2.5* 05:40am blood digoxin-3.5* lenis : findings: grayscale and doppler son of bilateral common femoral, superficial femoral and popliteal veins were performed. there is normal compressibility, flow and augmentation. flow in the visualized superficial calf veins is normal. impression: no evidence of dvt. . cath : comments: 1. initial angiography of the aortic arch was obtained revealing a type 1 aortic arch without critical stenosis atthe level of the arch. images were ovbtained non-selectively via a 5 french tennis racquet catheter. selective images were then obtained of the right and then the left carotid arteries with a 5fr 1 catheter. the right common carotid: minimal disease, right ica has a 65% lesion proximally just distal to the cca bulb. the right ica fills the ipsilateral ac and mca intracerebrally with cross-filling noted of the contralateral aca. the left common carotid artery is normal. the left ica has a tubular 80% stenosis present involving the bulb and extending into the proximal left ica. the ica fills the ipsilateral aca and mca as well as providing some cross-filling to the contralateral aca. 2. successful ptca and stenting of the left ica utilizing spider filter for distal protection. successful deployment of a self-expanding tapering 6-8x40mm protege carotid stent which was post dilated to 4.5mm. final angiography revealed a 10% residual stenosis, no angiographically apparent dissection and brisk flow (see ptca comments). the patient left the lab free of angina and in stable condition. 3. limited hemodynamics revealed a central aortic pressure of 196/69. final diagnosis: 1. left internal carotd disease brief hospital course: #carotid stenosis: pt with carotid stenosis found on screening us. relatively high risk of stroke based on the degree of stenosis. she was evaluated by cardiovascular medicine and underwent cath on . angiography demonstrated: right common carotid: minimal disease, right ica has a 65% lesion proximally just distal to the cca bulb. the left common carotid artery is normal. the left ica has a tubular 80% stenosis present involving the bulb and extending into the proximal left ica. the ica fills the ipsilateral aca and mca as well as providing some cross-filling to the contralateral aca. left ica was successful ptca and stented utilizing spider filter for distal protection. final angiography revealed a 10% residual stenosis, no angiographically apparent dissection and brisk flow. the patient was observed in ccu overnight. required phenyleprine to maintain bp systolic range 100-140. normal neuro exam post stenting. her pcm backup rate was increased from 40bpm to 50bpm givnen her symptomatic bradycardia. her pressor was weaned the morning following admission. her digoxin, amlodipine, lisnopril, lasix and imdur were discontinued until her scheduled outpatient follow up with cardiology. her carvedilol was held pre-cath and she was instructed to restart this medication on the day following discharge. . #bradycardia/mobitz 1: the mobitz 1 heart block is new since her last admission and she descibes increased fatigue. the av block with slightly sccoped st segments and new fatigue all suggest possible digoxin toxicity. her digoxin level was elevated and her medication was held. her carvedilol was held pre-cath and she was instructed to restart her home dose on the day following discharge. concern because mobitz worsen with vagal stimulation (and carotid stents frequently complicated by high vagal tone so her pcm backup rate was increased to 50bpm as above. . #. cad: cardiac cath on showed stable coronary anatomy with known rca occlusion supplied by collaterals. no other significant coronary disease. she was continued on aspirin and plavix. continued on statin. her lisinopril, amlodipine, and imdur were held as above. . #. chronic kidney disease: baseline cr. of 1.7. estimated gfr of approximately 30. the patient received pre-cath hydration with ns at 60cc/hr on, more gentle given decreased ef. then 150meq bicarb at 120cc 1 hour prior to cath and 60cc/hr for 6hr after. also given nac 600mg po bid before and after. . #pvd: hx of claudication s/p poba to l profunda femoral artery. continued on asa, plavix, and pentoxifylline. . #htn: mildly hypertensive on admit. improved today. blood pressure medications held as above. . #dm: continued home glipizide and riss. . #hyperlipidemia: continued on atorvastatin, fenofibrate, and zetia. . # copd: continued fluticasone and prn albuterol . medications on admission: 1. digoxin 250 mcg po daily 2. atorvastatin 60 mg po daily 3. levothyroxine 50 mcg po daily 4. amlodipine 10 mg po daily 5. fenofibrate micronized 145 mg po daily 6. glyburide 10mg 2 tabs in am and 1 tab in pm 7. furosemide 120mg in am and 80 in pm 8. lisinopril 20 mg po daily 9. ezetimibe 10 mg po daily 10. pentoxifylline 400 mg sustained release po tid 11. nitroglycerin 0.4 mg tablet sublingual prn. 12. fluticasone-salmeterol 250-50 mcg/dose one inh 13. albuterol 90 mcg/actuation aerosol sig: one (1) inhalation every eight (8) hours as needed for shortness of breath or wheezing. 15. clopidogrel 75 mg po daily 16. aspirin 325 mg po daily 17. carvedilol 25 mg po twice a day. 18. isosorbide mononitrate sustained release 24 hr 60mg qam, 30mg qhs discharge medications: 1. atorvastatin 20 mg tablet sig: three (3) tablet po daily (daily). 2. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 3. fenofibrate micronized 145 mg tablet sig: one (1) tablet po daily (). 4. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 5. pentoxifylline 400 mg tablet sustained release sig: one (1) tablet sustained release po tid (3 times a day). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) 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 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 10. glyburide 5 mg tablet sig: four (4) tablet po qam (once a day (in the morning)). 11. glyburide 5 mg tablet sig: two (2) tablet po qpm. 12. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual prn chest pain: take one tablet under toungue every 5 minutes, up to 3 tablets, if still having chest pain, call 911. . 13. coreg 12.5 mg tablet sig: one (1) tablet po twice a day: start on . disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: 1. l internal carotid stenosis s/p carotid stenting 2. peripheral vascular disease 3. bradycardia 4. ischemic cardiomyopathy secondary: 1. diabetes mellitus 2. hypertension 3. hyperlipidemia discharge condition: good discharge instructions: you were admitted to the hospital for carotid artery stent placement. . your digoxin, amlodipine, lisnopril, lasix and imdur were discontinued. you should discuss restarting these with your usual cardiolgist dr. . you should restart your carvedilol tomorrow morning (). . however, do not take the following medications until directed to do so by your cardiologist: digoxin amlodipine imdur . you have started the medication plavix. you must continue to take this medication to prevent a blot clot formation in your carotid stent. you should never stop this medication unless directed to by your cardiologist. you should also continue to take your aspirin daily. . please contact your doctor or return to the emergency room if you develop worrisome symptoms such as dizziness, lightheadedness, shortness of breath or chest pain. . please maintain your scheduled follow up appointments listed below. followup instructions: you should follow up with your cardiologist dr. on friday at 1:15pm. please call with any questions about your appointment. dr. will discuss restarting your blood pressure medications at this time. . you should follow up with dr. and , appointment has been made for you withdr. on @ 10:30am. call ( with any questions or concerns. . you should then follow-up with dr. on @ 11:30am. call ( with any questions or concerns. . . provider: , md phone: date/time: 10:30 provider: , . provider: , a. procedure: arteriography of cerebral arteries aortography percutaneous angioplasty of extracranial vessel(s) percutaneous insertion of carotid artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism atherosclerosis of native arteries of the extremities with intermittent claudication hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified occlusion and stenosis of carotid artery without mention of cerebral infarction other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia other specified cardiac dysrhythmias personal history of malignant neoplasm of bladder automatic implantable cardiac defibrillator in situ chronic obstructive asthma, unspecified abdominal aneurysm without mention of rupture other malaise and fatigue cardiotonic glycosides and drugs of similar action causing adverse effects in therapeutic use other second degree atrioventricular block 

Answer: The patient is high likely exposed to