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: penicillins attending: chief complaint: weakness major surgical or invasive procedure: redo coronary artery bypass graft x 4 (left internal mammary artery to left anterior descending, saphenous vein graft to diagonal, saphenous vein graft to obtuse marginal, saphenous vein graft to posterior descending artery) cardiac cath history of present illness: 78 year old male with a history of coronary artery bypass surgery years ago, remote myocardial infarction, chronic atrial fibrillation, and diabetes type 2 presented to outside hospital with fatigue, weakness, cough and subjective fever. the week prior he was admitted to an outside facility for weakness which was thought to be secondary to inderal dosing. the patient saw his outpatient cardiologist following discharge, asked to wear a holter monitor which showed 3 second pauses. he was scheduled to return to dr. office this coming wednesday. . on the day of admission to hospital, the patient's daughter found him lying on the floor, unable to stand on his own. he denies any loc at that time. his initial vital signs were t 100.7, hr 102 (irregular) and bp 158/90. he had a cxr which showed evidence of a lul opacity. he was admitted for suspected pneumonia. he initially received levaquin and given iv fluids. as the patient became more wheezy on exam, a bnp was checked found to be 405. he was then treated with iv lasix x 1 (unclear dose). he became more dyspneic and hypoxic, then transferred to the icu. he was found to be in a rapid ventricular rate with a fib, and treated with iv lopressor. in the icu, a tte showed an ef of 20-25% with severe global hypokinesis, dilated la, mild tr, and no other valvular dysfunction. ce's were sent and the initial set showed ck 353, mb 20, trop i 15.5, then repeat at 2 am ck 395, mb 55, trop i 9.0, then prior to transfer was ck 1506, mb 299, trop i 43.3. he was given high dose aspirin, loaded with 600mg of plavix, and put on iv heparin for transfer. he was treated with iv lopressor for his rapid rate. . the patient on arrival to , was asymptomatic. he was initially transferred to the cath lab for suspected cardiac catheterization, but given his elevated inr, the decision was made to postpone cardiac cath until the am. past medical history: coronary artery disease with histoy of myocardial infarction and coronary artery bypass surgery diabetes mellitus hypertension chronic atrial fibrillation and right bundle branch block acute on chronic renal failure transient ischemia attack status post cholecystectomy chronic thrombocytopenia social history: pt married, has 3 children, lives at home with his wife - history: quit smoking 40 years ago -etoh: none -illicit drugs: none family history: multiple family members with cad physical exam: on dmission at ccu vs: t= 99 bp=124/67 hr=97 rr=18 o2 sat= 97% general: wdwn in 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 no elevation of jvp. cardiac: pmi located in 5th intercostal space, midclavicular line. irregularly irregular rhythm, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. rhonchi heard in segment, no crackles or wheezes. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. left upper extremity hematoma. pulses: right: carotid 2+ femoral 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ dp 1+ pt 1+ pertinent results: - inr 1.3 cardiac cath: 1. coronary angiography of this right dominant system demonstrated severe native three vessel disease. the lmca had no stenosis. the lad was heavily calcified and had serial long stenoses ~85% in the proximal to mid vessel. the lad was a large and patent in its mid to distal pole. the lcx was occluded. the rca was occluded. 2. venous conduit arteriography showed svg/rca and svg/om occlusion. 3. angiography of the lima for upcoming re-do cabg showed a large non-obstructed vessel. 4. resting hemodynamics revealed elevated right and left ventricular enddiastolic filling pressures at 14 and 15 mmhg, respectively. the pcwp was 20 mmhg. the mean pa pressure was 27 mmhg (phasic 40/16 mmhg). the cardiac index was depressed at 1.6 l/min/m2. the mean systolic arterial pressure was 71 mmhg (phasic 105/51 mmhg). chest ct: 1. multifocal areas of ground-glass opacities involving mainly the upper lobes. differential diagnosis is broad and includes pneumonia and ards, although the distribution is not typical. edema is less likely due to lack of other signs. 2. atherosclerotic changes as described above. 3. cardiomagaly. 4. mediastinal lymphadenopathy. carotid u/s: right ica stenosis <40%. left ica stenosis <40%. echo: pre-bypass: 1. the left atrium is moderately dilated. no mass/thrombus is seen in the left atrium or left atrial appendage. mild spontaneous echo contrast is present in the left atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). no atrial septal defect is seen by 2d or color doppler. 2. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. there is mild to moderate regional left ventricular systolic dysfunction with . overall left ventricular systolic function is moderately depressed lvef= 30 %). 3. the right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. 4. there are simple atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). trace aortic regurgitation is seen. 6. the mitral valve leaflets are moderately thickened. moderate (2+) mitral regurgitation is seen. post-bypass: for the post-bypass study, the patient was receiving vasoactive infusions including milrinone and norepiepinephrine and is being av paced. 1. lv ventricular function and rv function are unchanged. 2. mr is still moderate 3. aortic contours appear intact. 4. other findings are unchanged brief hospital course: as mentioned in the history of present illness, mr. was transferred from outside hospital to icu at for further cardiac work-up. in addition to being medically managed for a non-st elevation myocardial infarction, he received treatment for congestive heart failure, atrial fibrillation and pneumonia. on he was brought for a cardiac cath which revealed severe three vessel disease and totally occluded saphenous vein grafts. cardiac surgery was consulted for redo bypass surgery. he underwent further work-up which included chest ct and carotid u/s prior to surgery. his status slowly improved while receiving medical management over the next week. during this time, both his kidney and liver function showed improvement with continuous lab work. on he was brought to the operating room where he underwent a redo coronary artery bypass graft x 4. please see operative report for surgical details. following surgery he was transferred to the cvicu for invasive monitoring in stable condition. within 24 hours he was weaned from sedation, awoke neurologically intact and extubated. his chest tubes and temporary pacing wires were removed per cardiac surgery protocol. he was started on betablocker, diuretic, statin and aspirin therapy. he was transferred from the icu on pod#2. his post op course was uneventful with the exception of failing to void. the foley was replaced and he was started on flomax. coumadin was resumed for afib but at a lower dose than his home regimen. he was seen by physical therapy and reab was recommended. medications on admission: lasix 20mg daily, coumadin 2.5mg tue, , sat, sun and 5mg on mon, wed, fri, allopurinol 100mg daily, propranolol 10mg qid, amlodipine 5mg daily, glyburide 2.5mg daily, aspirin 81mg daily discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for temperature >38.0. 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po daily (daily) as needed for constipation. 6. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed. 7. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily): needs follow up lft's in one month. 8. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 9. glyburide 2.5 mg tablet sig: one (1) tablet po bid (2 times a day). 10. warfarin 1 mg tablet sig: as directed tablet po daily (daily) as needed for atrial fibrillation : inr goal 2-2.5 rec'd 2.5 mg . 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 12. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 13. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) ml inhalation tid (). 14. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 15. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 16. lasix 20 mg tablet sig: one (1) tablet po twice a day for 7 days: then decrease to 20mg daily ongoing. discharge disposition: extended care facility: rehabilitation and nursing center - discharge diagnosis: coronary artery disease myocardial infarction systolic congestive heart failure pneumonia status post coronary artery bypass graft chronic atrial fibrillation and right bundle branch block diabetes mellitus acute on chronic renal failure transient ischemia attack chronic thrombocytopenia discharge condition: deconditioned discharge instructions: please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month, and while taking narcotics no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: please call and schedule the following appointments. dr. in 4 weeks dr. in weeks dr. in weeks md procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery left heart cardiac catheterization coronary arteriography using a single catheter angiocardiography of right heart structures diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation chronic kidney disease, unspecified diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled right bundle branch block old myocardial infarction other complications due to other cardiac device, implant, and graft personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits other encephalopathy acute systolic heart failure 

Answer: The patient is high likely exposed to