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: ace inhibitors attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization without angioplasty or stent placement history of present illness: this is a 77 y.o. male with cad s/p mi in , dm, htn, and hyperlipidemia who awoke on the morning of at 3:00 am with chest pain. he describes the onset of feeling somewhat unwell after dinner, and then at 3:00 am he was woken up by left sided crushing chest pain that started quite mild but then progressively increased in intensity. he denies any radiation to his neck or arm. he reports this is similar to his previous ischemic symptoms. he denies any shortness of breath or diaphoresis. he may have felts slightly light-headed but has difficulty fully clarifying this. this pain did awaken him from sleep and did not change on exertion. he called ems and was brought into the hospital. on arrival to the ed, vs t98, hr 56, bp 137/73, rr 20, o2 100% on ra. ekg w/ inferior borderline (barely 1 mm) ste w/ possible reciprocal changes. therefore, code stemi was called and he received aspirin, clopidogrel, heparin, and was started on epifibatide and nitroglycerin before going for cardiac catheterization. this revealed 3v disease including a likely culprit lesion in an om. unfortunately, intervention was not feasible given anatomy and extent of disease. epifibatide was stopped prior to leaving the cath lab due to a developing hematoma at the site of his arterial puncture. at the time of arrival to the ccu he denied any chest pain or other complaints. cardiac review of systems is notable for chest pain and chronic lower extremity edema. it is notably negative for dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors:+ diabetes, +dyslipidemia,+hypertension 2. cardiac history: -cabg: none. -percutaneous coronary interventions: none. -pacing/icd: none. 3. other past medical history: -cva in -cad s/p mi in -chronic lower extremity edema -prostate cancer s/p radiation >10 years ago -peripheral vascular disease -chronic systolic chf (lvef 44%) -hepatitis b, core antibody positive but negative viral load in , differential including cleared viral infection, but surface antibody negative versus laboratory error -osa social history: widower since , now lives alone, but lives in a multi-family house with his two sons and his daughter and grandchildren. he is retired from the wonderbread factory. he quit tobacco in , and alcohol in . no drug use. family history: father died at the age of 59 of unknown cause. mother died in her 80s from breast cancer. physical exam: vs: t 96.1??????f, hr 68, bp 139/74, rr 20, o2 sat 96% on 2l general appearance: well nourished, no acute distress, overweight / obese, no(t) anxious, no(t) diaphoretic eyes / conjunctiva: perrl, no(t) pupils dilated, no(t) conjunctiva pale, no(t) sclera edema head, ears, nose, throat: normocephalic lymphatic: cervical wnl cardiovascular: (pmi normal), (s1: normal), (s2: normal), (murmur: no(t) systolic, no(t) diastolic) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: diminished), (left dp pulse: diminished) respiratory / chest: (expansion: symmetric), (breath sounds: clear : anteriorly) abdominal: soft, non-tender, bowel sounds present, distended, obese extremities: right lower extremity edema: trace, left lower extremity edema: 1+, no(t) cyanosis, no(t) clubbing musculoskeletal: no(t) muscle wasting skin: warm, no(t) rash: , no(t) jaundice neurologic: attentive, follows simple commands, responds to: verbal stimuli, oriented (to): person, place, time, situation, movement: purposeful, tone: normal pertinent results: laboratory results ================== on admission: wbc-8.0 hgb-12.3* hct-37.8* mcv-95 mch-31.0 mchc-32.6 rdw-13.5 plt ct-188 ---neuts-79.0* lymphs-15.1* monos-4.2 eos-1.4 baso-0.3 na-139 k-5.7* cl-105 hco3-23 urean-25* creat-1.4* glucose-234* pt-12.1 ptt-25.3 inr(pt)-1.0 calcium-8.4 phos-3.8 mg-2.1 on discharge: wbc 7.5, hb 11.6*, hct 35.8*, mcv 94, plt 179 na 141, k 3.6, cl 107, hco3 25, bun 14, cr 1, glu 91 ca 9, mg 2.1, p 2.7 pt 12.2, ptt 35.5*, inr 1 cardiac enzymes: 03:50am blood ck(cpk)-442* ck-mb-6 ctropnt-<0.01 07:01am blood ck(cpk)-349* ck-mb-11* mb indx-3.2 ctropnt-0.04* 04:32pm blood ck(cpk)-569* ck-mb-38* mb indx-6.7* ctropnt-0.48* 12:41am blood ck(cpk)-721* ck-mb-52* mb indx-7.2* ctropnt-1.31* 06:37am blood ck(cpk)-639* ck-mb-41* mb indx-6.4* ctropnt-1.30* other studies ============== admission ekg: sinus rhythm. left axis deviation. there is a non-specific intraventricular conduction delay. there are q waves in the inferior leads with st segment elevation and terminal t wave inversions consistent with acute or evolving myocardial infarction. additional non-specific st-t wave changes. clinical correlation is suggested. compared to the previous tracing st segment elevation in the inferior leads is new. cardiac cath 1. selective coronary angiography in this right-dominant system demonstrated three-vessel disease. the lmca was long and without angiographically apparent disease. the lad had a long 40% stenosis in its proximal portion, followed by serial 70% and 90% stenoses in the mid and distal segments, respectively. the lcx had a 90% mid-vessel stenosis, the first obtuse marginal had a 50% stenosis and the second obtuse marginal had a 60% stenosis in its proximal portion and a 99% stenosis in its middle portion. the rca had a long 50% stenosis proximally, an 80% distal stenosis and a 90% distal stenosis involving the bifurcation. 2. limited resting hemodynamics revealed mildly elevated systolic blood pressure with an sbp of 147 mm hg and a dbp of 85 mm hg. final diagnosis: 1. three vessel coronary artery disease. 2. inferior stemi. tte the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with inferior hypokinesis. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. mild (1+) aortic regurgitation is seen. 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. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. compared to the prior report dated , minimal as is now present. cxr : single ap view of the chest: the heart is normal in size. the aorta is mildly tortuous. the lungs are clear without consolidation or edema. there is no pleural effusion or pneumothorax. impression: no acute cardiopulmonary abnormality. brief hospital course: 77 y.o. male with known cad and previous imi as well as dm, htn, and pvd presenting with chest pain and found to have likely stemi by ekg. cardiac catheterization showing non-intervenable disease, and he admitted to the ccu for medical management of mi. 1)stemi/cad: patient's ekg showed evidence of inferior stemi. patient was taken the cath lab emergently, and was found to have diffuse 3 vessel disease. no intervention was attempted because of the diffuse nature of the disease. patient was then admitted to ccu for medical management. patient came to the floor on nitro gtt, which was promptly turned off, and he was chest pain free during the rest of his hospital stay. patient was kept on heparin gtt after cath for 48 hours. this was then stopped without new chest pain. he was continued on aspirin, aggrenox, and beta-blocker. his was restarted prior to discharge at a higher dose for greater blood pressure control as well as lose dose hydralazine & imdur. patient's cardiac enzymes were monitored until they started to fall. mild inferior wall hypokinesis was seen on tte, but he had an essentially normal ef of 45-50%. clopidogrel was considered given that he sustained stemi; however, decision was made not to start this because of his history of stroke, the fact that he is already on aspirin and aggrenox, his age, and his history of hematochezia. 2. hypertension: patient has a history of poorly controlled hypertension, and on the outpatient pcp note, patient's valsartan was recently increased from 160mg to 200mg daily. patient's valsartan and lasix were initially held during this admission because of acute renal failure, receiving contrast during cath, and in the setting of acute stemi. on the day prior to discharge, valsartan and furosemide were re-started. he continued to have some difficulties with elevated blood pressure, particularly on exertion so that valsartan was uptitrated to 320 mg daily and low dose isosorbide and hydralazine were started. 3. chronic systolic chf: patient appeared euvolemic. repeat tte showed ef 45-50%, down from 55% in . to reduce the risk of contrast-induced nephropathy, patient was given gentle hydration (500cc ns). his respiratory status was stable throughout his hospital stay. 4. acute kidney injury: patient presented with creatinine of 1.4, up from baseline of 1.2 unclear etiology, possibly dehydration/prerenal given nearly 20:1 bun:cr ratio, and feurea of 33.6. patient was also at risk for further injury from cin. patient was given gentle hydration (500cc ns). lasix and valsartan were held initially. his creatinine returned to his baseline 1 on the day of discharge. 5. history of cva: patient has no residual deficits. aggrenox was continued. 6. diabetes mellitus: reasonably well controlled, last a1c is 7.5. patient was put on glargine and insulin sliding scale during this hospital stay. his glucose was well-controlled. 7. pad: no acute issues, aspirin was continued. the patient was on heparin drip for most of his hospitalization and thus had dvt prophylaxis. no gi prophylaxis was indicated. he was full code after discussion with him. medications on admission: -atenolol 75 mg daily -dipyramidole-asa 1 tab -furosemide 40mg daily -tamsulosin 0.4 mg daily -valsartan 160 mg daily -asa 81 mg daily -insulin 70/30 32u in am -nph 12u in pm discharge medications: 1. dipyridamole-aspirin 200-25 mg cap, multiphasic release 12 hr sig: one (1) cap po bid (2 times a day). 2. insulin asp prt-insulin aspart 100 unit/ml (70-30) solution sig: thirty two (32) unit subcutaneous qam. 3. nph insulin human recomb 100 unit/ml cartridge sig: twelve (12) unit subcutaneous qpm. 4. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 5. niacin 250 mg capsule, sustained release sig: one (1) capsule, sustained release po bid (2 times a day). disp:*60 capsule, sustained release(s)* refills:*2* 6. pravastatin 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 7. niacin 250 mg capsule, sustained release sig: one (1) capsule, sustained release po bid (2 times a day). 8. aspirin 81 mg tablet sig: one (1) tablet po once a day. 9. valsartan 320 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 10. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 11. hydralazine 10 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 12. isosorbide dinitrate 30 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 13. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnoses: - st elevation myocardial infarction - coronary artery disease secondary diagnoses: - hyperlipidemia - hypertension - diabetes mellitus ii discharge condition: afebrile, hemodynamically stable, chest-pain free mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - requires assistance or aid (walker or cane) discharge instructions: you were admitted to because of chest discomfort that was due to a heart attack. you were taken for cardiac catheterization, which showed diffuse coronary artery disease involving all of your coronary arteries. no intervention was possible due to the distribution and diffuse nature of the disease. this pattern of disease also makes surgery not a reasonable option currently. after discussion between dr. and the team caring for you in the ccu, we will continue to medically manage your coronary artery disease. your medications have been changed. - please make sure to take aspirin 81mg daily in addition to dipyridamole-aspirin twice a day - please take niacin sr 250 mg twice a day, you should take it together with dipyridamole-aspirin to reduce side effects from the niacin - please take pravastatin 40mg daily to decrease your cholesterol level - please take valsartan 320 mg daily, this is a higher dose compared to your previous dose - please take hydralazine 10 mg and isosorbide dinitrate 30 mg three times/day; you should take these pills together at the same time - your atenolol has been replaced by metoprolol succinate (toprol xl) 100 mg daily followup instructions: you need to see dr. , your cardiologist, within the next two weeks. please call the cardiology office at ( on monday to make an appointment. other appointments: provider: , md date/time: at 1:45 pm phone: provider: , md date/time: at 8:00 am phone: procedure: coronary arteriography using two catheters left heart cardiac catheterization diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled personal history of malignant neoplasm of prostate chronic systolic heart failure acute myocardial infarction of inferolateral wall, initial episode of care atherosclerosis of native arteries of the extremities, unspecified 

Answer: The patient is high likely exposed to