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: chief complaint: chest pain reason for admission to ccu: inferior stemi major surgical or invasive procedure: cardiac catheterization with des to rca history of present illness: mr. is a 59y/o gentleman with no significant pmh besides obesity and who presented to the ed due to chest pain and is being admitted to the ccu s/p cardiac cath with rca stenting for inferior stemi. . he was in his otherwise good state of health until 2am today when he developed acute onset of chest pain that woke him up from sleep. it is described as substernal/left sternal pressure radiating to the jaw. was associated with mild sob but no nausea or diaphoresis. he was concerned that he might be having a heart attack so he took an asa and called ems. received another asa by ems and arrived to the ed at 4:40am. . in the ed, initial vitals were hr 63, bp 168/95, rr 16, pox 99% 2l nc. over the next hour his bp increased to 196/114, hr up to 120. labs and imaging significant for trop-t 0.07. cr was 1.7. ekg showed st elevations in ii, iii, avf and st depressions in i, avl as well as v1-v2. patient was given 1l normal saline, morphine 5mg iv, plavix 600mg po, was started on heparin gtt and was taken to the cath lab. there, he was found to have rca 95% lesion which was stented as well as a mid-lad 80% lesion with no intervention. he was still hypertensive and tachycardic. he was started on a ntg drip for hypertension and received metop 5mg iv x4 for tachycardia. right groin was angiosealed, right venous sheath in place. after the procedure he complained of some chest tightness similar to his symptoms and he was given lasix 20mg iv. . on arrival to the ccu, patient feels well. no more shortness of breath. no chest pain. he is glad that he called ems. he mentions that though he does not exercise, at his baseline he is very active at work as a landscaping contractor. he can usually walk more than 5 flights of stairs before becoming short of breath, and he has never had chest pain before today. . review of systems 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. 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: obesity ed visits for minor cuts/injuries no surgeries social history: -home: lives alone with his dog. close with his brother and sister. -occupation: landscape contractor. -tobacco history: never smoked. -etoh: very occasional use (a few drinks per year); no h/o heavy use in the past. -illicit drugs: never used any illicits. family history: no known h/o mi. father had hypertension. mother had hypertension and died of ovarian cancer. sister died of an attack. physical exam: admission physical examination: vs: t=98 bp=152/102 hr=98 rr=12 o2 sat=90-95% 4l nc general: obese gentleman in nad heent: eom intact, mmm neck: supple, no jvd cardiac: s1 and s2, no murmur, no heave lungs: cta throughout all fields bilaterally; no wheezes abdomen: soft, nondistended, no mass extremities: no edema skin: no rash pulses: right: carotid 2+ dp 2+ left: carotid 2+ dp 2+ . discharge physical exam: vitals - tm/tc:99.1/98.7 hr:107-114 bp:148-176/105-115 rr:18-20 02 sat: 96% ra general: obese gentleman in nad heent: eom intact, mmm neck: supple, no jvd cardiac: s1 and s2, no murmur, no heave lungs: cta throughout all fields bilaterally; no wheezes abdomen: soft, nondistended, no mass extremities: no edema skin: no rash pulses: right: carotid 2+ dp 2+ left: carotid 2+ dp 2+ pertinent results: admission labs: 05:00am blood wbc-11.7* rbc-5.66 hgb-15.7 hct-48.7 mcv-86 mch-27.8 mchc-32.3 rdw-13.8 plt ct-266 05:00am blood pt-10.2 ptt-25.8 inr(pt)-0.9 05:00am blood fibrino-372 11:50am blood glucose-126* urean-18 creat-1.1 na-140 k-4.6 cl-106 hco3-25 angap-14 05:00am blood cholest-206* 05:00am blood triglyc-151* hdl-50 chol/hd-4.1 ldlcalc-126 11:50am blood calcium-8.7 phos-2.7 mg-2.1 05:00am blood %hba1c-5.5 eag-111 . discharge labs: 06:03am blood wbc-9.6 rbc-5.08 hgb-14.0 hct-43.8 mcv-86 mch-27.6 mchc-32.1 rdw-14.3 plt ct-206 06:03am blood glucose-79 urean-25* creat-1.1 na-136 k-3.8 cl-103 hco3-24 angap-13 . cardiac enzyme trend: 11:50am blood ck(cpk)-909* 11:50am blood ck-mb-138* mb indx-15.2* ctropnt-1.10* 10:00pm blood ck(cpk)-1087* 10:00pm blood ck-mb-142* mb indx-13.1* ctropnt-1.71* 05:33am blood ck-mb-82* ctropnt-1.38* . ekg: acute inferoapical st segment elevation myocardial infarction with reciprocal st segment depression in leads i, avl and v1-v3. the underlying rhythm is probably sinus with ventricular and atrial ectopy as well as variable a-v block. suggest clinical correlation and repeat tracing. no previous tracing available for comparison. . ekg: normal sinus rhythm. borderline first degree a-v block. diffuse non-specific st-t wave abnormalities. st segment elevation in the inferoapical leads and reciprocal st segment depression are no longer seen. suggest clinical correlation. . tte: the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild to moderate regional left ventricular systolic dysfunction with near akinesis of the inferior and inferolateral walls and mild hypokinesis of the remaining segments (lvef = 30-35 %). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with regional and global systolic dysfunction c/w multivessel cad or other diffuse process. mild mitral regurgitation. . cardiac catheterization: brief hospital course: mr. is a 59y/o obese gentleman with no known cad risk factors who presented to the ed with an inferior wall stemi, and was admitted to the ccu s/p cardiac cath with des to rca. during his stay, he was started on cardiac meds and was discharged home. #. inferior stemi: with chest pain, elevated cardiac enzymes, ekg changes. patient presented to the ed with a few hours of crushing chest pain, ekg findings suggested inferior wall stemi. cath lab emergently activated and patient received a des to 95% stenotic rca. patient arrived to ccu chest pain free and hemodynamically stable. of note, patient still with residual cad including a lad 80% stenosis which was not intervened upon. patient was plavix loaded with 600mg then transitioned to daily 75 mg, he also received aspirin, atorvastatin and started on metoprolol xl and lisinopril for continued tachycardia and hypertension. tte after catheterization showed mild symmetric left ventricular hypertrophy with regional and global systolic dysfunction c/w multivessel cad or other diffuse process. mild mitral egurgitation. ef 30-35%. he will follow-up with dr. in cardiology clinic. #. hypertension, tachycardia: still not at goal. patient has body habitus for hypertension thought tachycardia likely in setting of stress reaction. patient also with family history of htn so he almost definitely has essential hypertension that has gone undiagnosed as he has no pcp. epinephrine for could also contribute, though he says he did not use just prior to admission. hypertension was managed as above with troprol xl and lisinopril. at the time of d/c home, he was still not at goal (hr 90-100, bp 145-175/105-115) but he insisted upon leaving prior to optimization, especially because he believed that agitation from being in the hospital and sleeping poorly was contributing to these vital signs. he was discharged on metoprolol xl 150mg daily and lisinopril 30mg daily; he will buy a bp cuff and will communicate with np, in order to titrate his meds as an outpatient. in addition, he will establish care with a provider at with hopes of optimizing hr and bp. #. shortness of breath: resolved. history of for which patient uses epinephrine. chf weas considered though his clinical signs and symptoms did not suggest acute volume overload. patient was treated with lasix 20mg ib x1 and albuterol mdi for which his sob improved. of note, patient does not like albuterol nebs and prefers mdi. he was advised to stop using epinephrine because this could be dangerous. he was reminded to adress his with his new pcp; he may benefit from albuterol mdi +/- flovent. #. obesity: likely reflects metabolic syndrome. he will follow up with his pcp regarding weight loss. #. hyperlipidemia: lipids not at goal. he was started on atorvastatin and will f/u with his pcp and cardiology. #. ?pre-diabetes: hba1c 5.5%. by some assays this can represent pre-dm. weight loss will certainly help. he will follow up with his pcp. #. creatinine 1.2: unclear baseline. gfr 62. cr was 1.1 upon d/c. #. transaminitis: likely nafld. ast 176 and alt 47, which could suggest etoh but he denies any heavy etoh use. could be nafld. he should follow up this issue with his pcp. transitions of care: - outpatient uptitration of toprol xl and lisinopril by , np and new pcp will require plavix for at least one year and aspirin indefinitely - discuss changing aspirin from 325mg to 81mg daily with cardiologist - lad lesion will either be intervened on electively or managed medically unless chest pain develops - workup of transaminitis by pcp assessment/management by pcp medications on admission: primatene inhaler prn (epinephrine 0.22 mg ), no longer available in the usa discharge medications: 1. plavix 75 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*11* 2. aspirin 325 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet sublingual as directed as needed for chest pain: take 1 tab, wait 5 min, take one more tab if pain persists. call 911 for pain after 2 tabs. disp:*25 tablets* refills:*0* 5. metoprolol succinate 100 mg tablet extended release 24 hr sig: 1.5 tablet extended release 24 hrs po daily (daily). disp:*45 tablet extended release 24 hr(s)* refills:*2* 6. lisinopril 30 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: st elevation myocardial infarction hypertension hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted because you had a heart attack. you underwent a cardiac catheterization procedure, and a stent was placed in one of the blood vessels of your heart. in addition, you were found to have a separate blockage in another of the heart's arteries which was not opened at this time. you have been started on medicines to help prevent the blockage from becoming worse and causing another heart attack. at this point, it is very important that you keep taking daily aspirin and plavix (to make sure that the stent stays open). do not stop taking aspirin and plavix or miss unless dr. tells you it is ok. in addition, you were started on blood pressure and cholesterol medications to help prevent the heart from having another heart attack. please follow-up with cardiology (appointment listed below) in order to manage your coronary artery disease, especially with respect to future plans for the heart blockage which was not yet stented. take your blood pressure and heart rate every day at home. please keep a log of these readings for your doctor appt. in addition, it is important to establish care with a primary care doctor healthcare maintenance (for weight loss and control). we have made an appointment for you (listed below). the following changes were made to your medications: -start aspirin daily -start plavix daily (for at least 1 year, please discuss this with dr. -start atorvatatin for cholesterol (which was high) -start lisinopril for blood pressure (which has been high) -start metoprolol to protect the heart -start nitroglycerin tablets under the tongue if you have chest pain at home. take one tablet, wait 5 minutes, take one more tablet if you still have chest pain. call 911 if chest pain persists aftr 2 nitroglycerin. call dr. if you have any chest pain at home. . please weigh yourself every morning, call dr. if weight increases more than 3 pounds in 1 day or 5 pounds in 3 days. followup instructions: department: when: wednesday at 3:45 pm with: , md building: sc clinical ctr campus: east best parking: garage dr is your new physician at . he works closely with dr , both will be involved in your care. please call your insurance and name dr. as your pcp. must be done before your appointment. . department: cardiac services when: at 1:00 pm with: , md building: campus: east best parking: garage department: cardiac services when: thursday at 11:00 am with: echocardiogram building: sc clinical ctr campus: east best parking: garage md, procedure: coronary arteriography using two catheters left heart cardiac catheterization 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 asthma, unspecified type, unspecified other and unspecified hyperlipidemia other specified cardiac dysrhythmias acute myocardial infarction of other inferior wall, initial episode of care obesity, unspecified other abnormal glucose nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] 

Answer: The patient is high likely exposed to