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: sulfa (sulfonamide antibiotics) attending: chief complaint: chest pain major surgical or invasive procedure: cardiac cath coronary artery bypass grafting x3, left internal mammary artery graft to left anterior descending, reverse saphenous vein graft to diagonal branch and the marginal branch history of present illness: the patient is a 70 year old female with history of dm, hypertension, and recurrent pulmonary emboli who had an abnormal stress test at and was transferred to for catheterization. the patient reports having intermittent chest pain for the past 4 years. during stress testing, she developed doe and st depressions in the inferior leads. cardiac cath on at revealed lm disease. she was referred for revascularization. she is currently denies chest pain. past medical history: diabetes mellitus hypertension hyperlipidemia morbid obesity recurrent pulmonary emboli breast cancer s/p l mastectomy, xrt, and hormone therapy melanoma -- upper left arm, s/p resection s/p l mastectomy 5 years ago s/p melanoma resection 5 years ago umbilical hernia repair 10 years ago spinal cyst removal social history: race: caucasian last dental exam:: upper dentures, has not seen a dentist in several years lives with:lives with husband, daughter, and daughter's boyfriend. occupation: : quit 6 years ago. smoked 1-1.5 ppd previously. etoh: none family history: mother, maternal grandmother, brother -- dm and cad father -- cad siblings -- sister with parkinsons (deceased), sister with lung disease (deceased), sister with dm (deceased) physical exam: physical exam pulse: resp: 16 o2 sat: 99% ra b/p right: 114/60 left: height:5'6" weight: 110.4 kg general: skin: dry intact le with chronic venous stasis changes heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally distant breath sounds, bibasilar crackles heart: rrr irregular murmur abdomen: soft non-distended non-tender bowel sounds + obese, well healed umbilical scar extremities: warm , well-perfused edema 2+ l>r varicosities: none neuro: grossly intact pulses: femoral right: 2+ left:2+ dp right:1+ left:1+ pt :1+ left:1+ radial right:2+ left:2+ carotid bruit right: none left: none pertinent results: 04:42am blood wbc-8.4 rbc-3.03* hgb-9.2* hct-27.3* mcv-90 mch-30.4 mchc-33.8 rdw-17.1* plt ct-326 08:05am blood wbc-8.1 rbc-4.03* hgb-12.5 hct-36.5 mcv-91 mch-31.1 mchc-34.3 rdw-15.4 plt ct-317 04:42am blood pt-23.0* inr(pt)-2.2* 08:05am blood pt-23.7* ptt-25.5 inr(pt)-2.2* 04:42am blood urean-32* creat-0.9 na-136 k-4.4 cl-100 08:05am blood glucose-126* urean-36* creat-1.1 na-139 k-4.4 cl-101 hco3-25 angap-17 09:25pm blood alt-21 ast-23 ld(ldh)-180 alkphos-74 totbili-0.4 echocardiography report , (complete) done at 2:19:51 pm final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 70 f hgt (in): 66 bp (mm hg): 110/70 wgt (lb): 250 hr (bpm): 72 bsa (m2): 2.20 m2 indication: cabg icd-9 codes: 786.05 test information date/time: at 14:19 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2011aw04-: machine: echocardiographic measurements results measurements normal range left atrium - long axis dimension: *4.8 cm <= 4.0 cm left atrium - four chamber length: 4.7 cm <= 5.2 cm left ventricle - septal wall thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.8 cm <= 5.6 cm left ventricle - ejection fraction: 55% >= 55% aorta - ascending: *3.8 cm <= 3.4 cm aortic valve - peak velocity: 1.0 m/sec <= 2.0 m/sec aortic valve - lvot diam: 2.0 cm findings left atrium: dilated la. no spontaneous echo contrast or thrombus in the la/laa or the ra/raa. right atrium/interatrial septum: normal ra size. no asd by 2d or color doppler. left ventricle: mild symmetric lvh with normal cavity size and regional/global systolic function (lvef>55%). right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. focal calcifications in aortic root. mildly dilated ascending aorta. focal calcifications in ascending aorta. normal aortic arch diameter. focal calcifications in aortic arch. normal descending aorta diameter. focal calcifications in descending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. trace ar. mitral valve: mildly thickened mitral valve leaflets. trivial mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. no tee related complications. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. conclusions pre-bypass: the left atrium is dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. t he ascending aorta is mildly dilated. there are focal calcifications in the aortic arch. t he aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results on . post_bypass: normal biventricular systolic function. remaining findings are the same as prebypass. intact throacic aorta. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 09:25 ?????? caregroup is. all rights reserved. brief hospital course: mrs. was admitted to the on for further management of her chest pain and abnormal stress test. her coumadin was stopped and she was placed on lovonox as a bridge for cardiac catheterization. on mrs. underwent a cardiac catheterization which revealed severe left main and multivessel coronary disease. given the severity of her disease, the cardiac surgical service was consulted for surgical revascularization. she was worked-up in the usual preoperative manner including a carotid duplex ultrasound which showed then 40% stenosis of her bilateral internal carotid arteries. she was noted to have a urinary tract infection for which she was treated with ciprofloxacin. on , mrs. was taken to the operating room where she underwent coronary artery bypass grafting to three vessels (left internal mammary artery grafted to left anterior descending artery. saphenous vein grafted to diagnal/obtuse marginal). please see operative note for details. cardiopulmonary bypass time= 62 minutes. cross clamp time= 51 minutes. postoperatively she was taken to the intensive care unit for monitoring. over the next 24 hours, she awoke neurologically intact and was extubated. beta blockade, aspirin and a statin were resumed. her coumadin was also resumed given her history of pulmonary embolism. her diabetes medications were resumed and titrated based on her blood sugars. all lines and drains were discontinued in a timely fashion. she was transferred to the step down unit for further recovery. physical therapy was consulted for evaluation of her strength and mobility. she was gently diuresed towards her preoperative weight. ms. continued to make steady progress and was discharged to lifecare center of rehabilitation on postoperative day #6. all follow up appointments were advised. her coumadin will be managed by dr. once she has been discharged from rehabilitation. her lisinopril can be resumed as an outpatient as her blood pressure tolerates. medications on admission: medications at home: atenolol 25 mg po daily amlodipine 10 mg po daily hctz 25 mg po daily lisinopril 40 mg po daily simvastatin 10 mg po daily warfarin 2.5 mg po daily - last dose friday - followed by pcp 1000 mg po bid lantus 50 units qhs humalog sliding scale tid multivitamin 1 tab po daily calcium 500 mg po daily discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po at bedtime. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 1 months. 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. metformin 500 mg tablet sig: two (2) tablet po bid (2 times a day). 7. warfarin 1 mg tablet sig: as instructed for goal inr 2.0-2.5 tablets po once daily at 4 pm: please adjust dose as needed for goal inr 2.0-2.5. discharge dose is 2.5mg daily. 8. lasix 40 mg tablet sig: one (1) tablet po once a day for 14 days. 9. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day for 14 days. 10. insulin sliding scale and fixed doses please see attached sheet 11. metoprolol tartrate 25 mg tablet sig: two (2) tablet po twice a day. 12. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 13. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever, pain. 14. insulin glargine 100 unit/ml cartridge sig: one (1) subcutaneous q am: 40 units q am. 15. insulin glargine 100 unit/ml cartridge sig: one (1) subcutaneous q pm: 30 units q pm. 16. warfarin 1 mg tablet sig: md tablet po daily (daily): inr 2-2.5 for history of recurrent pe. 17. warfarin 1 mg tablet sig: 0.5 tablet po once for 1 doses. 18. insulin lispro 100 unit/ml cartridge sig: one (1) subcutaneous achs: per sliding scale. discharge disposition: extended care facility: lifecare center of discharge diagnosis: coronary artery disease s/p coronary artery bypass graft x 3 past medical history: diabetes mellitus hypertension hyperlipidemia morbid obesity recurrent pulmonary emboli breast cancer s/p l mastectomy, xrt, and hormone therapy melanoma -- upper left arm, s/p resection s/p l mastectomy 5 years ago s/p melanoma resection 5 years ago umbilical hernia repair 10 years ago spinal cyst removal 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 right/left - healing well, no erythema or drainage. 1+ edema 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. date/time: 1:00 cardiologist: dr. in weeks. a message has been left at his office to call you to schedule an appointment. if you do not hear from him, please call to schedule. ( please call to schedule appointments with your primary care dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication: history of recurrent pe goal inr: >2 first draw: daily->1st draw results to phone fax procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters (aorto)coronary bypass of two coronary arteries left heart cardiac catheterization central venous catheter placement with guidance diagnoses: coronary atherosclerosis of native coronary artery mitral valve disorders urinary tract infection, site not specified unspecified essential hypertension personal history of malignant neoplasm of breast other and unspecified hyperlipidemia morbid obesity long-term (current) use of anticoagulants personal history of venous thrombosis and embolism diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled personal history of malignant melanoma of skin body mass index 39.0-39.9, adult 

Answer: The patient is high likely exposed to