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: demerol attending: chief complaint: dsypnea major surgical or invasive procedure: cardiac catheterization history of present illness: 81yo f with h/o cabg in (vein grafts pda, om, and om-2) and subsequent interventions (most recent pci in ) who presented to an osh with dyspnea. patient endorsed worsening sob and l arm pain since saturday (3 days ago). ros was also + for cough. in the osh ed, she was noted to have ecg changes and a + troponin of 4. she was given asa, enoxaparin, and plavix load. her ua was positive and she had a leukocytosis, she she was also given ctx and levofloxacin before transfer here. she also recieved a dose of lasix 40mg iv for pulmonary edema. in our ed, cards was consulted and recommended giving atorvastain 80. twi were noted in v2-v6, i, and avl. she had evidence of pulmonary edema and and elevated bnp in the ed. she was admitted to for management of her nstemi and chf exascerbation. . in the ed, initial vitals were t98.0, hr 65, bp 117/97, rr 17, o2 sat 99% 2l nc. labs and imaging significant for bnp , trop-t: 0.68, wbc 20.4, cr 1.7, cxr showed mild to moderate interstitial edema and small pleural effusions. ua + for large leuk, 90 wbcs, and few bacteria. patient given levaquin (750mg), ceftriaxone (1g), plavix (300mg), lasix (40mg iv), asa (325), lovenox (70mg) at osh and atorvastain 80mg here. vitals on transfer were hr 57, bp 142/57, rr 15, o2 sat 97% 2l nc . on arrival to the floor, patient is anxious about going to cath. . review of systems on review of systems, she denies current cp or sob. she denies any urinary sx. all of the other review of systems were negative except as noted above. past medical history: 1. cardiac risk factors: diabetes, + dyslipidemia, + hypertension 2. cardiac history: -cabg: (vein grafts pda, om, and om-2) -percutaneous coronary interventions: ptca to lad and lcx in , ptca to rca in , rotablation and stent to rca in , cath in at hospital -pacing/icd: 3. other past medical history: left carotid endarterectomy and dacron patch angioplasty in gerd. hysterectomy. removal of basal cell carcinoma of nose. hypothyroidism cervical ca (40 years ago) atrial fibrillation chronic systolic heart failure social history: - originally from , moved here 40+ years ago. -tobacco history: never smoked -etoh: has one cocktail daily at 5pm with her husband -illicit drugs: none family history: both parents died from heart disease. no family hx of dm physical exam: 5'2" 145# vs: t=97.9 bp=130s/60s-80s hr=62 rr=16 o2 sat=100% on 2l general: wdwn elderly female in nad. alert, axious, tearful. heent: ncat. sclera anicteric. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp to 3cm above the clavicle. cardiac: rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. expiratory crackles in the bases b/l abdomen: soft, ntnd. extremities: no c/c/e. chronic venous stasis changes noted of the way up the calves b/l pertinent results: admission labs: 06:30am blood wbc-20.4*# rbc-3.52* hgb-11.8* hct-34.0* mcv-97 mch-33.6* mchc-34.8 rdw-15.9* plt ct-135* 06:30am blood neuts-93.9* lymphs-4.0* monos-2.0 eos-0 baso-0.1 06:30am blood pt-15.1* ptt-34.5 inr(pt)-1.3* 06:30am blood glucose-125* urean-26* creat-1.7* na-140 k-3.4 cl-105 hco3-24 angap-14 06:30am blood ck-mb-22* mb indx-7.0* probnp-* 06:30am blood calcium-8.8 phos-2.5* mg-2.2 06:33am blood lactate-1.7 . 06:30am blood ctropnt-0.68* 05:40am blood ck-mb-11* mb indx-6.9* ctropnt-0.83* . cath 1. selective coronary angiography demonstrated native 3-vessel coronary artery disease. the lmca was diffusely diseased with 30-40% stenosis. the lad gave rise to three diagonal vessels free of significant disease. there was a 90% mid-vessel stenosis. the lcx was occluded proximally. one om and part of the lcx proper filled retrograde via collaterals from the lad. the rca was occluded at its ostium. the r-pda and rlv as well as the distal rca filled via left to right collaterals from the lad. 2. supravalvular aortography demonstrated all three vein grafts were flush occluded as was the native rca. only the lmca filled. 3. limited resting hemodynamics revealed normal central aortic pressure. final diagnosis: 1. three vessel coronary artery disease with all three vein grafts occluded and the entire coronary circulation supplied via the lad which is significantly compramised by a mid-vessel stenosis. this is the likely culprit for the nstemi. 2. recommend cardiac surgery evaluation for cabg suitability versus pci of the lad. . cxr findings: frontal and lateral views of the chest demonstrate stable appearance of median sternotomy wires and multiple clips related to prior coronary bypass grafting. the heart is top normal in size. thoracic aorta is mildly tortuous. there is increased perihilar vascular congestion and a few peripheral kerley b lines, suggestive of mild interstitial edema. there is no pneumothorax. small pleural effusions are noted posteriorly. trace retrocardiac atelectasis is present. cholecystectomy clips are present. mpression: mild to moderate interstitial edema and small pleural effusions. big la conclusions prebypass no atrial septal defect is seen by 2d or color doppler. there is moderate regional left ventricular systolic dysfunction with akinesia of the apex, apical, mid and basal portions of the inferior wall. the apical and mid portions of the inferoseptal and inferolateral walls are hypokinetic. overall left ventricular systolic function is moderately depressed (lvef= 35 %). with mild global rv free wall hypokinesis. there are simple atheroma in the aortic arch. 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 moderately thickened. there is mild valvular mitral stenosis (area 1.5-2.0cm2). moderate (2+) mitral regurgitation is seen. there is no pericardial effusion. dr. was notified in person of the results on /2011at 900am. poor image quality that somewhat improved once the chest was open. post bypass patient is a paced and receiving an infusion of phenylephrine amd milrinone. biventricular systolic function is unchanged. aorta is intact post decannulation. moderate mitral regurgitation persists. i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, interpreting physician 07:54 . brief hospital course: 81yo f who presented to osh with dyspnea who was found to have ecg changes and elevated troponin consistent with nstemi, chf exacerbation and and ua/leukocytosis indicative of uti. she received a 3-day course of quinolones, and ucx was ultimately negative. she went to cardiac cath soon after arrival to the cardiology floor. she was found to have occluded all of her svgs as well as her rca and lcx. she also has a tight lad stenosis. she has collaterals from the left to the rca territory. cardiac surgery was consulted, and the plan was made for a re-do cabg on , . plavix was stopped to allow for washout prior to surgery. she was continued on asa, heparin gtt, metoprolol, and atorvastatin 80. she had some dyspnea on exertion while on the medical floor, but no chest pain or other acute anginal equivalent. her ef was 35% on echo, compared to "low normal" from osh in . global hypo- or akinesis is consistent with prior data. her admission cxr was consistent with mild-moderate pulmonary edema on admission, and she had gentle diuresis early in her hospital course. her ace-i was held given arf, which slowly trended back towards baseline. she was continued on her amiodarone and was well rate-controlled on the cardiology floor. . the patient was brought to the operating room on where the patient underwent: 1. urgent re-do coronary artery bypass graft x5: left internal mammary artery to left anterior descending artery and saphenous vein sequential grafting to obtuse marginal 1 and 2 and saphenous vein grafts to posterior descending artery and diagonal artery. 2. endoscopic harvesting of the long saphenous vein. overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. pod 1 found the patient extubated, alert and oriented and breathing comfortably. the patient was neurologically intact and hemodynamically stable, weaned from inotropic and vasopressor support. beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. the patient was transferred to the telemetry floor for further recovery. chest tubes and pacing wires were discontinued without complication. she went back into a fib and amiodarone therapy continued. picc placed for access and then removed when access obtained.evaluated also by clinical nutrition team. the patient was evaluated by the physical therapy service for assistance with strength and mobility. by the time of discharge on pod #10 the patient was ambulating freely, the wounds were healing and pain was controlled with oral analgesics. creat 1.5 on day of discharge. ( close to baseline). the patient was discharged to ne in rehab in good condition with appropriate follow up instructions. medications on admission: simvastatin 40mg qday levothyroxine 50mcg daily amiodarone 100mg ( tablet) daily metoprolol succinate 25mg daily bumex 1mg daily lisinopril 10mg daily nitroglycerin prn asa 81mg discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. 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:*2* 4. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 2 weeks. 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily) for 2 weeks. 7. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units sc injection injection tid (3 times a day). 8. hydralazine 50 mg tablet sig: one (1) tablet po every six (6) hours. 9. amiodarone 200 mg tablet sig: one-half tablet po daily (daily): 100 mg daily. 10. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb ih inhalation q4h (every 4 hours): with chest pt. discharge disposition: extended care facility: - discharge diagnosis: coronary artery stenosis dyslipidemia,hypertension,gerd,hypothyroidism atrial fibrillation discharge condition: alert and oriented x3 nonfocal ambulating, gait steady sternal pain managed with oral analgesics sternal incision - healing well, no erythema or drainage le: discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 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 **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge followup instructions: you are scheduled for the following appointments: surgeon dr. @ 1:00 pm cardiologist dr. please call to schedule the following: 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** md procedure: single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters left heart cardiac catheterization (aorto)coronary bypass of four or more coronary arteries diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism coronary atherosclerosis of autologous vein bypass graft atrial fibrillation personal history of other malignant neoplasm of skin acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to