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: patient recorded as having no known allergies to drugs attending: chief complaint: date: . outpatient cardiologist: , . chief complaint: sscp major surgical or invasive procedure: cardiac cath history of present illness: history of presenting illness: . patient is a 73 y/o f w/ a hx of cad, s/p des to om1, , chf no echo on file, paroxysmal afib, not on anticoagulation, severe pulmonary htn on viagra 20mg tid, hx of copd home oxygen of 4l, pvd, pud, who presents on to hospital with nausea/vomiting, abdominal pain, acute on chronic renal failure w/ cr of 2.1, found to have bp in of 196/99, dig level of 4.6, w/ 5mg iv morphine, 2.5mg iv lopressor w/ improvement of bp to 140/60 and hr in 90s. nausea and vomiting had been going on for 3 days prior to presentation. . patient's n/v and renal failure were thought to be secondary to dig toxicity. an abdominal non-contrast ct scan was done which showed no acute finding, atrophic r kidney, and sigmoid diverticula. they suspected patients findings were secondary to dig toxicity. . at 4am on patient developed severe sscp w/ radiation to her back the pain continued for 30minutes. patient was noted to have ecg findings significant for 3mm st depression in leads v3-v6, 2mm st elevation in avr, 2-3mm downward sloping st depressions in leads 2, 3, avf. patient was noted to have bp 183/88 in l arm and 155/97 in l arm. . patient was transferred to for work up of a possible aortic dissection. past medical history: percutaneous coronary intervention, in anatomy as follows: . comments: 1. coronary angiography of this right dominant system demonstrated single vessel coronary artery disease. the lmca had a 30% distal stenosis. the lad had diffuse irregularities. the lcx had 70% disease in the mid-om1. there was a 70% ostial stenosis of a small av branch. the rca had diffuse irregularities. 2. limited resting hemodynamics revealed normal systemic arterial hypertension (125/57 mm hg). 3. successful ptca and stenting of a 70% om1 lesion was performed with a 2.5x23 mm cypher stent. final angiography revealed 0% residual stenosis, no dissection, and timi 3 flow. (see ptca comments) . final diagnosis: 1. single vessel coronary artery disease. 2. successful ptca and drug-eluting stenting of om1 . other past history: pmhx: pvd cad w/ known stents oxygen dependent w/ chronic dyspnea, 4l home o2. pulmonary htn, came in on viagra afib copd past gi bleeds chf prior left carotid endarerectomy social history: patient quit smoking 10 years ago. she started at age 12 for a greater than 50 pack year history. no etoh or illicit drugs. lives at home with husband. to complete daily adls. family history: nc physical exam: physical examination: vs - t 96.9, hr 90, bp l arm 170/90, r arm 160/80 gen: wdwn middle aged male 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 jvp of 14 cm at 90 degree cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. distant heart sounds. no thrills, lifts. no s3 or s4. chest: crackles bilaterally, way up posteriorly. abd: soft, ntnd. no hsm or tenderness. ext: trace edema lower ext, weak dp/pt bilaterally pulses: right: carotid 2+ femoral 2+ popliteal 1+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 1+ dp 1+ pt 1+ pertinent results: osh labs sodium 138=>133 k 4.7 cl 99 bicarb 26 bun 27=>37 cr1.5=>2.1 glucose 180-210 . bnp 3395 . normal lfts . lipase 37 . dig level 4.7 . wbc 11.78=>10.5 hct 32.6 plt 248 . ck 60 trop 0.06=>0.10 . abg=7.47/35/72/ admission labs: . 09:30am blood wbc-8.9 rbc-4.53 hgb-12.5 hct-37.8 mcv-83 mch-27.6 mchc-33.0 rdw-16.2* plt ct-251 09:30am blood neuts-91.6* bands-0 lymphs-6.5* monos-1.7* eos-0.1 baso-0.1 09:30am blood pt-11.8 ptt-23.5 inr(pt)-1.0 09:30am blood glucose-197* urean-34* creat-1.6* na-130* k-4.7 cl-92* hco3-25 angap-18 09:30am blood alt-18 ast-31 ld(ldh)-326* ck(cpk)-264* alkphos-56 amylase-65 totbili-0.6 09:30am blood albumin-3.9 calcium-8.8 phos-4.2 mg-1.5* cholest-156 09:30am blood triglyc-144 hdl-47 chol/hd-3.3 ldlcalc-80 09:30am blood tsh-0.65 cardiac enzymes . 09:30am blood alt-18 ast-31 ld(ldh)-326* ck(cpk)-264* alkphos-56 amylase-65 totbili-0.6 02:40pm blood ck(cpk)-837* 12:20am blood ck(cpk)-244* 06:00am blood ck(cpk)-606* 05:15am blood ck(cpk)-pnd 09:30am blood ck-mb-26* mb indx-9.8* ctropnt-0.21* 02:40pm blood ck-mb-88* mb indx-10.5* ctropnt-2.04* 12:20am blood ck-mb-88* mb indx-36.1* ctropnt-3.95* 06:00am blood ck-mb-65* mb indx-10.7* ctropnt-3.54* digoxin levels . 09:30am blood digoxin-5.0* 06:00am blood digoxin-4.5* 05:15am blood digoxin-3.2* tte the left atrium is elongated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with focal basal inferior/inferolateral hypokinesis. the remaining segments contract normally (lvef = 50%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). transmitral doppler and tissue velocity imaging are consistent with grade i (mild) lv diastolic dysfunction. right ventricular chamber size and free wall motion are normal. there are focal calcifications in the aortic arch and in the descending thoracic aorta. no dissection flap seen in the aortic arch. the aortic valve leaflets (?number) are moderately thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. mild (1+) aortic regurgitation is seen. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: symmetric left ventricular hypertrophy with mild regional systolic dysfunction, c/w cad. calcific aortic valve disease with minimal stenosis and mild regurgitation. diastolic lv dysfunction with elevated filling pressures. moderate pulmonary hypertension. . findings discussed with dr. at 1305 hours on the day of the study. cxr chest (pa & lat) . reason: mediastinal widening. . indication: possible aortic dissection. evaluate for mediastinal widening. . mediastinal width is normal. the aorta is tortuous and calcified. the heart is mildly enlarged, and there is slight upper zone vascular redistribution, accompanied by vascular indistinctness and a bilateral interstitial pattern affecting the right lung to a greater degree than the left. additionally, there are subtle patchy areas of increased opacification in the right mid and both lower lung regions. no pleural effusions or acute skeletal abnormalities are identified. . impression: . 1. diffusely tortuous and calcified thoracic aorta, but no direct radiographic signs to suggest aortic dissection. because chest radiographs are not very sensitive for detecting dissection, an mra of the aorta could be considered given clinical concern for avoiding iodinated contrast. . 2. cardiomegaly and asymmetrical parenchymal opacities that are likely due to asymmetrical edema from chf. followup radiographs after diuresis would be helpful to confirm resolution and to exclude a more chronic interstitial abnormality. cta chest w&w/o c&recons, non-coronary 1:44 pm . ct chest post-administration of intravenous contrast: . there are extensive increased interstitial markings throughout both lungs. the appearances are suggestive of diffuse pulmonary fibrosis. there are scattered pulmonary nodules within the background interstitial change with the largest measuring 9 x 8 mm in the left lower lobe. there are several tiny mediastinal lymph nodes with the largest measuring 17 x 10 mm. the pulmonary arteries are enlarged. there is no definite pulmonary embolism. there is coronary artery atherosclerosis present. there is extensive calcified and noncalcified plaque in the aorta. there is no pericardial or pleural effusion. . the liver and spleen appear unremarkable. . musculoskeletal: there is a wedge compression through the superior end plate of one of the mid-thoracic vertebral bodies. there are no worrisome bone lesions. . conclusion: . 1. extensive interstitial changes in the lungs are consistent with diffuse fibrosis. there are several scattered pulmonary nodules and enlarged mediastinal lymph nodes. a pet ct is advised to rule out an underlying malignancy. . 2. enlarged pulmonary arteries suggestive of pulmonary arterial hypertension. coronary and aortic atherosclerosis is present. . the findings were added to the critical results communication dashboard. cardiac cath : r dominant. lmca 40-50% with distal taper lad: modest diffuse calcification, no critical lesion lcx; previous stent widely patent rca: dominant vessel with origin dampening and 70% with mid-segment 60% hazy lesion. intervention: cyper stent proximal rca 70% lesions, poba to midsegment lesion. ct abd/pelvis: 1. no evidence of intraperitoneal or retroperitoneal hematoma. 2. retention of contrast within the renal cortices bilaterally. correlation with the time of previous administration of contrast is recommended as atn cannot be excluded. segmental lack of enhancement of thinned areas of renal cortex bilaterally likely relates to chronic scarring. 3. cardiomegaly, coronary artery calcifications and pulmonary edema. small bilateral pleural effusions. 4. sigmoid diverticulosis, without evidence of diverticulitis. tte there is mild symmetric left ventricular hypertrophy. there is mild regional left ventricular systolic dysfunction with inferior hypokinesis. there is no ventricular septal defect. there is mild global rv free wall hypokinesis. the aortic valve leaflets are moderately thickened. the study is inadequate to exclude significant aortic valve stenosis. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mitral regurgitation is present but cannot be quantified. there is no pericardial effusion. . compared with the prior study (images reviewed) of , rv systolic function is less vigorous. brief hospital course: mrs. is a 73 y/o f w/ hx of copd, home o2 of 4l, paroxysmal afib in nsr, not on anti-coagulation, moderate pulm htn, cad s/p des to om1, chf w/ ef of 50% who presents to osh w/ nausea, vomiting, digoxin toxicity, acute on chronic renal failure who was then transferred to for sscp. sscp lasted for 30 min radiating to the back, initial ? of aortic disection at osh. patient arrived at , cta not done because of renal failure. no enlarged medistinum on cxr. tte did not show any ai. discussed checking for aortic disection on tee, but felt to be high risk if patient was ischemic, which we felt more likely the case. patient ruled in for an nstemi trop peak 3.95. kept on heparin for the first 48 hours as timi was 6. viagra was held, so that nitrates could be given. . on 3rd day, patient was taken to cardiac cath where successful stenting of the ostial rca was completed. ptca of the mid rca also done, but unable to deploy stent. post-cath one hour after angioseal removal patient became hypotensive bp 60/40 and hypoxic 77% on 4l. patient mentating through out time period. a code was called. patient received fluids and bp came up to mid 90s. patient was transferred to ccu for further monitoring. noted to have stable hct. no rp bleed on ct, no groin hematoma, or other vascular access issue. bedside tte was done and there was no signs of tamponade, but new rv dysfunction was noted. thought to be due to long procedure involving rca where there were time periods of diminished coronary flow. patients anti-bp meds, diltiazem, bb, hydralazine and nitrates were held. pt received 2.5 l of fluid in ccu. sbp in mid 80s then 90s. called out to the general cardiology wards. on that time on a much reduced dose of lopressor. patient was still relatively hypotensive sbp in 90s on only one , bp had been in 160s, before on 4 bp agents. concern that their might have been rv infarct. bp meds held for this reason. . in the evening on patient had a large amount of epistaxis, followed by elevation in blood pressure to 200 mmhg and went into atrial fibrillation with rapid ventricular response. she also became acutely short of breath. rvr was controlled with metoprolol. it was felt that shortness of breath was due to hypertension causing elevated filling pressures and pulmonary edema. chest xray did not show significant pulmonary edema, but this would not necessarily be expected during the acute event as some time is required for transudate to develop. she was taken to ccu where bp was controlled and patient was diuresed. . patient came out to the general cardiology floor the following evening, and then the next morning triggered for respiratory distress and hypoxia 77% on 4l. she was placed on nrb, felt to be fluid overloaded. question of pna on cxr pt received one day of antibiotics, but on further pulm consultation not thought to be pna and abx stopped. she had been maintained on iv heparin, but still sub-therapeutic at times. pt still had impaired renal function w/ cr 1.4, but felt it necessary to r/o pe w/ cta. no pulmonary embolism on cta. ct also showed multiple pulmonary nodules, enlarged mediastinal lymphnodes and interstitial markings consistent with fibrosis. the pulmonary team was consulted for management of pulmonary issues and recommended diuresis intially and the addition of ccb. pt was diuresed w/ prn iv lasix, but renal function worsened in the setting of diuresis and dye load and becaome hypoinatremic, with rising bun. over 3 days cr 1.4=>2.3. diuresis was stopped and renal fn normalized. patients bp, resp, hr issues stabilized and she was transferred to rehab. . problems: . #hypoxia: problem at baseline at the time of d/c to rehab with o2 sat >93% on 4l. multifactorial due to copd, moderate pulmonary hypertension, question of underlying pulmonary fibrosis based on ct scan. also have had an element of fluid overload after the mi as she appears to have improved somewhat with diuresis but definitely dry on discharge with preserved ef and no need for further diuresis. ccb started for htn as well as for pulmonary hypertension. viagra held given the hypotension and mi but should be considered in f/u with her primary pulmonologist although if she takes this will not be able to take nitrates if has chest pain. . #copd: patient not felt to be in flare. continued on home dose of 10mg prednisone. received ipratropium nebs and advair. . #nstemi: patient ruled in for nstemi, trop max 3.95, des to rca and ptca of mid-rca. patient continued on aspirin, plavix, bb, atorvastatin 40mg. . #htn: hypotension and hypertension as in above narrative. patient bp regimen was modified to include a bb for post-mi benefit and rate control as well as a ccb for pulm hypertension and rate control. . #acute on chronic diastolic chf: preserved ef >55%. bb and ccb as above. . #paroxsysmal atrial fibrillation: patient was in nsr on admission, discharge and most of hospitalization. during period of bb withdrawal patient flipped into afib w/ rvr. patient later converted on her own. patient was kept on heparin and bridged over to coumadin and rate controlled with ccb and bb. on this regiment whe was maintained in nsr for most of the time and well rate controlled. . #. elevated digoxin: patient was noted to have elevated digoxin. all dig was held while pt at . dig level of 5.0=>3.2, trending down. . #. acute on chronic renal failure: on admission cr 1.6 reported to be 2.1 at osh, patient received dye load from cath and cta on and respectively, and was overdiuresed causing renal failure with cr 1.4=>2.3 in matter of 3 days. at this point diuretics were held with creatinine improving and at the time of discharge ot was 2.0. pls check in the next few days to make sure this continues to improve. . #pulmonary htn: held home viagra, so that nitrates could be given instead w/ out risking synergy leading to hypotension. . #gerd: cont pantoprazole while inpatient -episode of nausea and heart burn after eating yesterday . #full code . #patient was evaluated by physical therapy who thought that rehab was appropriate. #pt needs pulmonary, cardiac and pcp f/u within 2 weeks medications on admission: current medications: medications advair 250/50 1puff spiriva 1mg daily nexium 40mg daily nitro- 6.5mg tid lipitor 40mg qhs lasix 20mg po prn lopressor 25mg po bid asa ec 325mg daily -dur 200mg po bid cardizem 30mg po tid prednisone 10mg daily plavix 75mg daily citracal unknown daily potassium 10mg daily viagra 20mg tid cozaar ? po daily . discharge medications: 1. prednisone 5 mg tablet sig: two (2) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 7. diltiazem hcl 30 mg tablet sig: one (1) tablet po tid (3 times a day). 8. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 13. warfarin 2 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 14. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 15. bisacodyl 5 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily) as needed. 16. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 17. insulin lispro 100 unit/ml solution sig: as directed subcutaneous asdir (as directed). discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: nstemi elevated digoxin acute on chronic renal failure copd pulmonary artertial hypertension diastolic heart failure paroxysmal atrial fibrillation . secondary diagnosis gerd hypertension discharge condition: stable, 98% on 4l discharge instructions: mrs. you were transferred to out of concern for your chest pain. you were found to have had a non-st elevation myocardial infarction or heart attack. you were also noted to have an abnormal elevation in your digoxin and worsening kidney function. . please keep all of your follow up appointment. . please take all of your medications as prescribed. . we have given you sublingual nitroglycerin to take in the case that you have another episode of chest pain. if you have chest pain place one pill under your tongue every 5 minutes (only if you have not taken any viagra), until you have done this 3 times. if you have to do this please call 911. . please call 911 or go to the emergency department if you develop chest pain, worsening shortness of breath, or any other worsening of your overall condition. followup instructions: please follow up with your primary care physician . jr,ph#, in the next two weeks. . please follow up with your cardiologist dr. , in the next 2 weeks. , , phone: ( . please also schedule an appointment with your pulmonologist to be seen within 2 weeks. . . please draw creatinine in the next couple of days and early next week to make sure creatinine continues to improve. procedure: coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization arteriography of other intrathoracic vessels insertion of drug-eluting coronary artery stent(s) computerized axial tomography of thorax cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: other iatrogenic hypotension subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure aortic valve disorders other chronic pulmonary heart diseases peripheral vascular disease, unspecified personal history of tobacco use chronic kidney disease, unspecified postinflammatory pulmonary fibrosis cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypoxemia cardiotonic glycosides and drugs of similar action causing adverse effects in therapeutic use other dependence on machines, supplemental oxygen 

Answer: The patient is high likely exposed to