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: all allergies / adverse drug reactions previously recorded have been deleted attending: chief complaint: chest pressure/nausea major surgical or invasive procedure: coronary artery bypass grafting x4 with left internal mammary artery to left anterior descending coronary artery; reverse saphenous vein single graft from aorta to first diagonal coronary artery; reverse saphenous vein single graft from aorta to first obtuse marginal coronary artery; reverse saphenous vein single graft from aorta to the distal right coronary artery. cardiac cath history of present illness: 62 year old male who is transferred from osh for nstemi. he had nausea yesterday and then today developed a sensation of chest pressure. he felt lightheaded and dizzy and went to outside hospital. he had a positive troponin there and received lovenox, plavix, aspirin. he also developed a complete heart block. on arrival here, he is in normal sinus rhythm. his chest pressure has resolved. the complete heart block may have been a reperfusion rhythm or from a primary conduction disturbance. he was seen by the cardiology fellow - they will admit to the ccu. he is now being referred for cardiac catheterization for further evaluation. past medical history: diabetes dyslipidemia hypertension chronic hepatitis c cirrhosis, genotype 1a, diagnosed 's, reportedly to blood transfusion hodgkin's lymphoma s/p chemo, radiation, and bmt 22 years ago bone marrow transplant osteoarthritis of the knees hypothyroidism s/p splenectomy s/p cholecystectomy s/p hip fixation social history: race:african american last dental exam:6 months ago, upper partial lives with:wife occupation:employed as a police officer, last worked prior to knee surgery. tobacco: prior smoking x2 years socially, quit 30 years ago etoh:drinks 2-3 beers and 2 drinks of hard liquor daily family history: non-contributory physical exam: pulse:100 resp:16 o2 sat: 100/ra b/p right:182/86 left:195/90 height:6' weight:104 kgs general: skin: dry intact heent: perrla eomi neck: supple full rom no jvd chest: lungs clear bilaterally heart: rrr irregular no mrg abdomen:soft non-distended non-tender +bs extremities: warm , well-perfused edema-none varicosities: none neuro: grossly intact, mae-follows commands, nonfocal exam pulses: femoral right: cath site left: 2+ dp right: 2+ left: 2+ pt : 1+ left: 1+ radial right: 2+ left: 2+ carotid bruit no pertinent results: echo: prebypass: no spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild regional left ventricular systolic dysfunction with hypokinesis of the apex, apical and mid portions of the inferior and inferoseptal walls. overall left ventricular systolic function is mildly depressed (lvef= 45%). right ventricular chamber is normal. rv function is mildly depressed.there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. dr. was notified in person of the results at the time of the study. postbypass: patient is in sinus rhythm. patient is receiving an infusion of phenylephrine. lvef= 45%. rv function is mildly depressed. mild mitral regurgitation and mild aortic regurgitation persist. aorta is intact post decannulation. cath report: 1. selective coronary angiography of this right-dominant system revealed three-vessel coronary artery disease. the lmca was short with mild plaquing. the lad was heavily calcified with a near-ostial 70% tubular stenosis. d1 had a proximal tubular 65% in a large vessel. the mid-lad appeared possibly intramyocardial. the lcx was heavily calcified and had a proximal 60% stenosis before giving rise to a large om2. om2 had 60% stenoses in the main vessel prior to and separately after a branch vessel (the brnach having its own 60% stenosis at the origin). the av groove lcx had a 50% stenosis just after om2. the rca was heavily calcified (with calcification of the right coronary cusp) and had a near-ostial 70% stenosis before proximal 70%, mid 75% tubular, and distal diffuse 40% stenoses. 2. limited resting hemodynamics demonstrated mildly elevated left-ventricular filling pressures with an lvedp of 13 mmhg, and systemic arterial hypertension with a central aortic pressure of 155/78 mmhg. no gradient was seen across the aortic valve on left-heart pullback. 3. left ventriculography was deferred given mild renal insufficiency. ct abd/chest: 1. ground-glass opacity involving most of the right upper lobe corresponding to the abnormality on radiograph is with other smaller foci as above is most likely related to pneumonia or pneumonitis(including aspiration). the differential diagnosis is broad but includes asymmetrical pulmonary edema given hx of recent mi. would recommend a repeat radiograph or ct after appropriate treatment in six weeks. 2. no concerning arterial enhancing lesions displaying washout noted within the liver. small non-specific arterial enhancing foci within the right lobe are likely perfusional can be followed up with a repeat ct or mri in 6 months. 3. single right and left hypervascular adrenal lesions. these are most concerning for possibility of multifocal pheochromocytomas and correlation with serum markers is recommended. additionally, given the multifocality, the patient should be evaluated for possible syndromic associations (such as men 2). differential includes hypervascular lipid poor adenomas or hypervascular metastases but the latter is less likely given the lack of any primary tumor noted within the abdomen or chest. recommend endocrine evaluation of adrenal nodules. 4. mild-to-moderate atherosclerotic calcification within the intrathoracic and intra-abdominal aorta as detailed above. there is no significant calcification within the ascending aorta for pre-operative cabg planning. brief hospital course: 62yom with htn, dlp, dm presenting with symptomatic bradycardia in the 30's in the setting of third degree heart block with ventricular escape rhythm and presenting with nstemi whose hospital course included cardiac cath showing triple vessel disease requiring cardiac surgery evaluation and subsequent cabg. during pre-op evaluation, found to have adrenal lesions concerning for metastatic disease versus pheochromacytoma. ============= hospital course: - ================ # coronary artery disease/cad: patient presented with nstemi and had cardiac catherization on showing multivessel disease. cardiac surgery was consulted for cabg evaluation. patient was medically managed with aspirin, statin and . plavix was held in preparation for surgery. given heart block, beta-blockaged was also held. . # heart block: prior to presentation to , patient was reportedly in 3rd degree heart block. upon arrival to , he was in normal sinus rhythm. patient was monitored on telemetry during his hospitalization. av nodal blockade was held given this history. . # adrenal nodules: as part of pre-op evaluation, cardiac surgery requested a ct abdomen given history of hepatitis c. on ct, adrenal nodules were found with specific concern for pheochromacytoma versus metastatic disease. endocrine was consulted for work-up for pheo. serum and urine labs were sent showing...... prior to surgery, patient was started phenoxybenzamine if lesions are in fact pheo. . # chronic hepatitis c: hepatology was consulted prior to surgery for any pre-operative recommendations. no changes were made to management. on ct, right liver lesion was noted. radiology recommended follow-up ct in 6 months. . # htn: poorly controlled during admission prior surgery. anxiety appeared to contribute slightly to hypertension. patient was started on hydralazine and phenoxybenzamine with better control of bp. . # dm: patient's blood sugars were not controlled during admission with last a1c 9.8. endocrine recommended changing insulin regimen to..... with better control of blood sugars thereafter. =================== surgical service: - =================== on , dr. performed coronary artery bypass grafting surgery. for surgical details, please see operative note. #cardiac: experienced episode of paroxysmal atrial fibrillation on postoperative day three. converted back to normal sinus rhythm within 24 hours. given history of complete heart block, ep was consulted and recommended that amiodarone be avoided. rate control and management of his atrial tachycardia should be with beta blockade only. he was started on warfarin and dosed for a goal inr between 2.0 - 2.5. there was no indication for permanent pacemaker but ep followup will be required as an outpatient with dr. . prior to discharge, of heart monitor was arranged. no further episodes of atrial fibrillation were noted for the remainder of his hospital stay. inr at discharge was subtherapeutic at 1.1, and arrangements have been made with dr. to monitor warfarin as an outpatient. . #pulmonary: extubated within 24 hours. at discharge, room air saturations were 100%. . #neuro: awoke from surgery neurologically intact. no neurologic complications noted. . #renal: stable renal function postoperatively. responded well to diuretics. discharge creatinine was 1.1. . #id: required several days of intravenous cefazolin for leg thigh cellulitis. white count peaked at 16k. over several days, the erythema and white count improved. at discharge, he will remain on a day course of po keflex. white count at discharge was 12.7k. . #heme: required prbc's early postop to maintain hematocrit near 30%. discharge hematocrit was 29%. . #dispo: cleared for discharge to home on postoperative day nine. medications on admission: diltiazem hcl - 300 mg capsule, sust. release 24 hr - 1 capsule(s) by mouth in am diltiazem hcl - 240 mg capsule,degradable cnt release 1 capsule(s) by mouth once a day furosemide - 20 mg tablet - 1 tablet(s) by mouth in am insulin asp prt-insulin aspart - 100 unit/ml (70-30)solution - 30units in am // 40units in pm levothyroxine - 50 mcg tablet - 1 tablet(s) by mouth daily metformin - 1,000 mg tablet - 1 tablet(s) by mouth twice daily oxycodone-acetaminophen - 5 mg-325 mg tablet - 1 - 2 tablet(s) by mouth every four (4) hours as needed for pain valsartan - 320 mg tablet - 1 tablet(s) by mouth daily zolpidem - 10 mg tablet - 1 tablet(s) by mouth at bedtime aspirin - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth daily multivitamin daily plavix - last dose: 75mg, 300mg discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*1* 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day) for 2 weeks. disp:*28 tablet(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. disp:*60 capsule(s)* refills:*0* 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 6. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily): please have pcp check lfts after two weeks of therapy. disp:*30 tablet(s)* refills:*1* 7. potassium chloride 10 meq tablet sustained release sig: two (2) tablet sustained release po once a day for 2 weeks. disp:*28 tablet sustained release(s)* refills:*0* 8. lasix 20 mg tablet sig: one (1) tablet po once a day: take 40mg qd x 2weeks then decrease dose to 20mg qd. disp:*45 tablet(s)* refills:*1* 9. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 10. keflex 500 mg capsule sig: one (1) capsule po three times a day for 10 days. disp:*30 capsule(s)* refills:*0* 11. insulin nph & regular human 100 unit/ml (70-30) suspension sig: 30 units qam and 40units qpm units subcutaneous qam and qpm: 30mg qam/40mg qpm. 12. warfarin 2 mg tablet sig: as directed tablet po once a day: atrial fibrillaion- target inr 2-2.5 take 5mg on then as directed by dr . disp:*100 tablet(s)* refills:*1* discharge disposition: home with service facility: vna discharge diagnosis: coronary artery disease and myocardial infarction s/p coronary artery bypass graft x 4 past medical history: diabetes dyslipidemia hypertension chronic hepatitis c cirrhosis, genotype 1a, diagnosed 's, reportedly to blood transfusion hodgkin's lymphoma s/p chemo, radiation, and bmt 22 years ago bone marrow transplant osteoarthritis of the knees hypothyroidism past surgical history s/p splenectomy s/p cholecystectomy s/p hip fixation discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with percocet incisions: sternal - healing well, no erythema or drainage leg left - mild erythema or drainage; eccymotic medially from svh site to thigh w/ large area of firmness at medial aspect of knee. edema 1+ firm pedal edema bilat 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 1:15pm appointment with pcp dr on at 10am ****will need follow up ct abdomen to f/u liver lesions*** please come in 6 on tuesday at 11:00am for a wound check on your left leg with . cardiologist: dr on 3:00pm **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** inr check on call results to dr @ for coumadin dosing. procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters left heart cardiac catheterization diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery chronic hepatitis c without mention of hepatic coma diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism atrial fibrillation bone marrow replaced by transplant other and unspecified hyperlipidemia atrioventricular block, complete iron deficiency anemia, unspecified personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health osteoarthrosis, unspecified whether generalized or localized, lower leg chronic total occlusion of coronary artery paroxysmal supraventricular tachycardia personal history of hodgkin's disease neoplasm of unspecified nature of endocrine glands and other parts of nervous system 

Answer: The patient is high likely exposed to