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: bactrim / metformin attending: chief complaint: inferior stemi major surgical or invasive procedure: catheterization and stent of distal rca history of present illness: the patient is a 62 year old female with a medical history that includes diabetes and hypertension who presents from home with chest pain. she was in her normal state of health (chest pain free, able to ambulate up three flights of stairs in home w/out symptoms) until one week ago when she started to develop epigastric and substernal chest pain. she describes it as , constant, radiating to left shoulder and jaw, and associated with nausea. it was not worse w/ activity. she initially attributed it to acid reflux although it did not improve with antacids. she felt that it was getting progressively worse so she presented to . . in ed, initial vitals were 97 bp: 171/81 (168/70 right arm, 162/73 left arm) resp: 18 o(2)sat: 100. exam was unremarkable. ekg per report showed sinus rhythm, rate 94, 2mm st elevation ii, iii, avf with 1mm st depression in avl. initial labs notable for wbc count 13, creatinine 2.1, troponin-t 1.62. she was given 2slng with resolution of chest pain. cxr per report with no acute process. she was given aspirin 325mg, plavix 600mg, and heparin bolus and gtt, and sent to for urgent cardiac catheterization. . in the catheterization lab at , she was found to have complete occlusion of the distal rca, 80% disease of om1 and 70% disease of the proximal lad. the distal rca lesion was believed to be the culprit and she received one des with good angiographic result. she was given bivalrudin. got 230cc of dye. . in the ccu, she denies chest pain, shortness of breath. feels some tightness in back of throat. . on review of systems, s/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. s/he denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: +diabetes +hypertension 2. cardiac history: none 3. other past medical history: -gerd social history: - works as administrative assistant - lives in with husband, no children - tobacco history: remote, quit 40 years ago - etoh: denies - illicit drugs: denies family history: - mother: alive, 87 years old, multiple pci 10 years ago - father: died 40s, hodgkins disease - several uncles with myocardial infarction physical exam: admission exam: vs: afebrile, 135/51 hr: 65 95% room air general: 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 of 8cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. i/vi systolic murmur apex 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. r radial tr band in place skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ discharge exam: vs: 100.3, 98.8, 126/65 (108-126/47-65), 64 (54-68), 20, 98%ra weight: 99.1kg general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis, erythema of the oral mucosa. no xanthalesma. neck: supple with jvp of 8cm, unchanged. cardiac: pmi located in 5th intercostal space, midclavicular line. rrr, normal s1, s2. ii/vi early systolic murmur apex. no rubs or gallops noted 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 abdominal bruits. extremities: no c/c/e. no femoral bruits. r radial cath site without tenderness, erythema or hematoma. dressing c/d/i. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: osh labs: wbc count 13, creatinine 2.1, troponin-t 1.62 admission labs: 12:51am blood wbc-9.6# rbc-3.34* hgb-9.3* hct-28.3* mcv-85 mch-27.9 mchc-32.9 rdw-13.8 plt ct-162 12:51am blood pt-12.3 ptt-125.6* inr(pt)-1.1 12:51am blood glucose-224* urean-38* creat-1.8* na-136 k-4.7 cl-106 hco3-22 angap-13 12:51am blood alt-22 ast-87* ld(ldh)-382* alkphos-64 totbili-0.2 12:51am blood ck-mb-32* ctropnt-3.81* 09:12am blood ck-mb-15* ctropnt-2.95* 12:51am blood calcium-9.7 phos-2.8 mg-1.6 iron-20* cholest-133 12:51am blood caltibc-278 hapto-196 ferritn-70 trf-214 12:51am blood triglyc-135 hdl-41 chol/hd-3.2 ldlcalc-65 discharge labs: 07:20am blood wbc-7.0 rbc-3.17* hgb-8.9* hct-27.3* mcv-86 mch-28.0 mchc-32.5 rdw-13.7 plt ct-154 07:20am blood pt-11.9 ptt-29.9 inr(pt)-1.1 07:20am blood glucose-179* urean-46* creat-2.5* na-137 k-4.3 cl-107 hco3-23 angap-11 07:20am blood calcium-10.4* phos-3.3 mg-2.5 catheterization: 1. selective angiography of this right dominant system demonstrated 3 vessel coronary artery disease. the rca had a 100% distal occlusion that was thought to be the culprit lesion for the patient's inferior stemi. the rca gave off a small pda and a large network of rpls. the lmca was without angiographically significant coronary artery disease. the proximal lad appeared aneurysmal with a long, ulcerated 70% lesion, but the remainder of the lad was free of angiographically significant stenoses. the lcx had a focal 80% lesion in the om1, but was otherwise free of angiographically significant coronary artery disease. 2. limited resting hemodynamics revealed a normal systemic arterial blood pressure with a central aortic pressure of 138/68. 3. successful ptca and stenting of the distal rca with a 2.5x23mm promus rx stent which was postdilated to 2.5mm. final angiography demonstrated no residual stensis, no angigoraphically apparent dissection and timi iii flow (see ptca comments). final diagnosis: 1. three vessel coronary artery disease. 2. successful ptca and stenting of the distal rca with a des. 3. normal systemic arterial blood pressure. brief hospital course: mrs. is a 62 year old female with a medical history of hypertension and diabetes who presents from home with one week of symptoms concerning for angina, found to have inferior st elevation myocardial infarction, taken for urgent catheterization and found multivessel coronary artery disease with complete occlusion of distal rca, which was intervened on with one drug eluting stent with good angiographic result, transferred to ccu post-cath. . # inferior stemi: patient found to have st elevation in inferior leads with iii > ii and reciprocal depression in avl suggesting rca as the culprit vessel. she also had st depression in v1, which may have represented contiguous infero-basal involvement. likely this is a late presentation of her myocardial infarction given her symptoms have been going on for days and troponin-t was positive to 1.6 at , peak troponin was 3.81 at admission to the ccu. she was found to have complete occlusion of distal rca on cardiac catheterization. she was also found to have left circumflex and anterior descending disease on catheterization. it is not clear if these lesions are resulting in symptomatic ischemic heart disease and less likely that either is causative of her current presentation. she remained chest pain free after the catheterization. her lcx and lad disease will be medically managed at discharge. she was started on aspirin, plavix, metoprolol, and atorvastatin. on the morning of discharge, she had some mild chest pain when lying flat. ecg suggested some pericarditis. pain resolved when sitting upright. she was advised to not take nsaids at this time given her acute kidney injury. she will contact her pcp should her pain worsen. she will follow-up with cardiology regarding future management options: cabg vs repeat pci vs medical management. she will also have an echocardiogram at this time to assess her lv function. . # elevated creatinine: patient without known history of renal insufficiency with last creatinine recorded being 1.2 (), found to have elevated creatinine of 2.1 at admission of unclear /duration. given concern for contrast induced nephropathy after her cardiac cath, her lisinopril was held. at discharge, her creatinine was acutely worse at 2.5, likely a result of the dye load during catheterization. her lisinopril and metformin were held on discharge and patient was scheduled with close follow up () with her pcp, was instructed to have labs drawn the day prior to her appointment to ensure her creatinine improves. she was also advised to avoid nsaids at this time. . #diabetes: we held her metformin given elevated creatinine with large dye load during pci. she was started on an insulin sliding scale. her a1c during this admission was pending at discharge. she is only on metformin at home currently, which was not continued on discharge given her acute kidney injury. she will have close follow up with her pcp (), and provided her creatinine improves, can restart the metformin a few days s/p discharge. . #hypertension: blood pressure remained well controlled during this admission. her lisinopril was held, as discussed above, and she was started on metoprolol. . #code status: full #transitional issues -will require plavix for one year and aspirin 325mg for one month followed by 81mg daily given -has been started on atorvastatin and metoprolol during this admission -consider restarting lisinopril if creatinine improves -restart metformin provided creatinine improves -will follow up with pcp on . -will follow-up with dr. after discharge regarding management of her cad, she will have a repeat echo at this time () medications on admission: -lisinopril 20mg daily -metformin 1000mg -aspirin 81mg daily -folic acid 1mg daily -calcium 600mg and vitamin d discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. calcium 600 + d(3) 600 mg(1,500mg) -400 unit tablet sig: one (1) tablet po once a day. 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*2* 7. outpatient lab work please draw a basic chemisty panel on and fax results to dr. , r. (office #, fax #). 8. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. disp:*30 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: inferior wall stemi secondary diagnosis: diabetes hypertension gerd discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to the coronary care unit (ccu) at for management of your chest pain. you were found to have a heart attack and went to the cardiac catheterization lab urgently where we placed a drug-eluting stent in one of your heart arteries. you were given anti-platelet medications after your procedure. your chest pain resolved and you were monitored without any additional events. . please call your doctor or go to the emergency department if: * you experience new chest pain, pressure, squeezing or tightness. * you develop new or worsening cough, shortness of breath, or wheezing. * you are vomiting and cannot keep down fluids, or your medications. * if you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit, or have a bowel movement. * you experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * your pain is not improving within 12 hours or is not under control within 24 hours. * your pain worsens or changes location. * you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. * you develop any other concerning symptoms. . changes in your medication reconciliation: . * upon admission, we added: -aspirin 325mg by mouth daily for one month. following this, you should take 81mg by mouth daily. -plavix (clopidogrel) 75mg by mouth daily for 1 year -metoprolol extended release 50mg by mouth daily -atorvastatin 80mg by mouth daily -docusate sodium 100mg by mouth as needed for constipation . you should stop: lisinopril metformin * these medications have been stopped because of your acutely worsened kidney function. your primary care doctor can decide to restart them at your appointment on if your blood work comes back improved. please have your blood work drawn on . . * you should continue all of your other home medications as prescribed, unless otherwise directed above. you will need a follow up cardiac echo prior to your cardiology appointment. you should also get blood work drawn prior the day prior to your appointment with dr. . followup instructions: name: , r. location: healthcare - address: , , phone: appointment: thursday 11:00am *please discuss with your doctor about an echocardiogram prior to your cardiology follow up with dr. . department: cardiac services when: monday at 11:00 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 2:20 pm with: , md building: campus: east best parking: garage procedure: coronary arteriography using two catheters insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute myocardial infarction of other inferior wall, initial episode of care nonspecific abnormal results of function study of kidney 

Answer: The patient is high likely exposed to