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: dyspnea, stemi major surgical or invasive procedure: cardiac catheterization and placement of three bare metal stents history of present illness: ms. is a 84 yof with prior history of 3 vessel coronary artery disease, prior nstemi presenting as shortness of breath, chf (ef 25%), and copd who was in her usual state of health with almost daily dyspnea on exertion who developed shortness of breath associated with diaphoresis, nausea, and diarrhea this morning. she notes that her symptoms were similar to her usual symptoms, however, they did not go away throughout the day so she called her grandson. called ems who found st elevations in ii, iii, and avf as well as depressions in v3 and brought her to . she took 325 mg aspirin at home. past medical history: 1. coronary artery disease - prior nstemi in - recent hospitalization at for nstemi 2. chf - last ef 20% () 3. copd 4. recent gi bleed at (transfused 3 units rbcs, no endoscopy) 5. upper back pain, s/p spinal fusion 6. s/p left femoral neck fracture and left hip hemiarthroplasty with chronic hip pain social history: the patient lives alone in her home. her grandson and granddaughter are her primary caregivers. she denies alcohol use, and quit smoking 20 years ago. uses walker at baseline with back pain. husband of many years died in and pt admits to loneliness and sadness since although this is not new for her per family. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: en: pale elderly female, emotionally distressed by hospitalization and chest/abdominal pain pale skin heent: eomi. mmm. op clear. tongue midline neck: supple, without adenopathy or jvd. chest: lungs clear to auscultation with normal respiratory effort. cor: normal s1, s2. rrr. no murmurs appreciated. abdomen: + bs, tender to palpation in lower abdomen. soft, non-distended. + extremity: large hematoma at right groin access cath site. otherwise warm, without edema. 2+ dp pulses bilaterally. neuro: alert and oriented. cn 2-12 intact. motor strength intact in all extremities. . pertinent results: labs on admission: cbc 07:13pm blood wbc-7.7 rbc-2.70*# hgb-7.3* hct-22.6* mcv-84 mch-27.2 mchc-32.5 rdw-14.6 plt ct-199 07:13pm blood plt ct-199 chem 7 07:13pm blood glucose-117* urean-48* creat-0.8 na-138 k-4.7 cl-105 hco3-26 angap-12 lfts 07:13pm blood alt-8 ast-28 ck(cpk)-160 alkphos-44 totbili-0.3 cardiac biomarkers 07:13pm blood ck-mb-16* mb indx-10.0* ctropnt-0.55* 05:07am blood ck-mb-54* mb indx-11.6* ctropnt-1.46* other chemistry 07:13pm blood albumin-3.4* calcium-8.1* phos-3.7 mg-2.0 cholest-108 07:13pm blood triglyc-51 hdl-37 chol/hd-2.9 ldlcalc-61 11:10pm blood lactate-3.0* 05:24am blood lactate-1.2 11:10pm blood freeca-1.09* 11:10pm blood type- ph-7.27* comment-peripheral cardiac catheterization : comments: 1. coronary angiography in this right dominant system demonstrated three vessel disease. the lmca had mild luminal irregularities but no flow limiting stenosis. the lad had a mid subtotal occlusion after the 1st diagonal branch with collateral filling of the distal vessel. the lcx had an 80% proximal stenosis of om1. the rca had sequential 90% mid stenoses followed by a subtotal occlusion before the distal bifurcation of the pda and pl. there was minimal flow into the pl branch. 2. limited resting hemodynamics revealed mild systemic arterial hypertension with sbp 141mmhg and dbp 85mmhg. final diagnosis: 1. three vessel coronary artery disease. 2. acute subtotal occlusion of the distal rca. echo impression: mild symmetric left ventricular hypertrophy with normal cavity size and extensive systolic dysfunction c/w multivessel cad or other diffuse process. mild aortic regurgitation.minimal aortic valve stenosis. mild mitral regurgitation. compared with the prior study (images reviewed) of , the left ventricular cavity is smaller with improved inferolateral systolic function. the other findings are similar. clinical implications: the left ventricular ejection fraction is <40%, a threshold for which the patient may benefit from a beta blocker and an ace inhibotor or . based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. brief hospital course: # stemi: in the ed, initial vitals were: hr 100 bp 126/72 rr 24 sat 98%. the patient was given plavix 600 mg, integrillin, and heparin. she was taken to the cath lab where she was found to have timi 1 flow in a large rpl branch and serial lesion in the rca. she was given three overlapping bare metal stents. she developed a moderate hematoma during case which was compressed and remained stable, but for this reason she was not continued on integrellin. she was chest pain free at the end of case but with residual st elevations. she then developed mild chest discomfort and was tachycardic. she was given iv lopresser 2.5 mg and the chest discomfort resolved. her echo showed ef 30% and extensive systolic dysfunction consistent with multivessel cad or other diffuse process but with improved inferrolateral systolic function compared with prior. she will need to continue the aspirin 81 mg (lower dose given gi bleed below), plavix 75 mg for at least one month, atorvastatin 80 mg, metoprolol, and lisinopril. she will need to follow up with her cardiologist and primary care, dr. on friday . . # gi bleed: after her catheterization the patient had 300 cc of melenotic stool. ng lavage was performed and revealed evidence of old coffee ground blood. gi was consulted who decided that she should be supported medically given her recent procedure/stemi. (of note, the patient was recently admitted to in where she had a gi bleed and refused endoscopy at that time) rbcs were requested, but due to antibodies, the pt had to request blood products from the red cross. the patient was found to be hypotensive to the low 80s/high 70s and was bolused with lr until she received 3 units of rbcs. she was started on a protonix drip and had no evidence of further bloody stools. her hct remained stable and her lactate was not elevated. it was thought that her bleed was likely from an upper source in the setting of receiving heparin, integrillin, plavix, and aspirin. she was initially made npo, but her diet was advanced slowly and she tolerated this well. her beta blocker, acei, and lasix were initially held and restarted before discharge. h pylori is currently pending. she has an appt with outpt gastroenterologist at and was encouraged to keep the appt. . # groin hematoma: the patient developed a large right hematoma as a complication from her catheterization. no bruits were auscultated. she was not continued on integrellin post cath for this reason. the hematoma remained stable and should improve over time. . # back pain: the patient has chronic back pain at baseline. to treat her pain she was given morphine 1 - 2 mg q 4 hr while she was npo. she was also given tylenol 1 gm q 6 hours and lidoderm patch which she said did not improve the pain. therefore, she was sent home with no change to her pain regimen. . # depression: noted by pt appearance and history. gerontology consult called and recommended 15 mg remeron qhs to treat depression, help her sleep and possibly improve her appetite. this medicine should be uptitrated to effect by pcp. agree with plan and pt encouraged to make her wishes clear about further medical therapy. a social work consult was asked for on page 1 to help her with end of life decision making. . # urinary urgency: pt stated she felt like she had uti on day of discharge, long history of these after foley catheterization. u/a mostly bland and cx pending. given symptoms, pt was sent home on 3 day course of ciprofloxacin. medications on admission: aspirin 325 mg q day atorvastatin 80 mg tablet q day carvedilol 3.125 mg furosemide 40 mg q day lisinopril 2.5 mg tablet q day discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. calcium 500 + d 500 mg(1,250mg) -200 unit tablet sig: one (1) tablet po twice a day. 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 6. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 8. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 9. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 10. furosemide 20 mg tablet sig: 0.5 tablet po twice a day. 11. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet sublingual every 5 minutes x3 as needed for chest pain. 12. lidoderm 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) patch topical once a day. disp:*30 patches* refills:*2* 13. ciprofloxacin 250 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 3 days. disp:*6 tablet(s)* refills:*0* discharge disposition: home with service facility: caregroup discharge diagnosis: primary diagnosis: st elevation myocardial infarction gi bleed (source unknown) right groin hematoma depression secondary diagnosis: low back pain systolic chf discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent discharge instructions: you came to the hospital because you were having shortness of breath and were found to be having a heart attack. you were emergently taken to the cath lab where you received three bare metal stents to your blocked artery. you had some leaking of blood from your blood vessel in your groin after the procedure. you also developed bleeding from your rectum and this was thought to be from bleeding up near your stomach. you were given red blood cells and iv fluids and the bleeding stopped. please note the following changes to your medications: 1. continue plavix every day to prevent the stent from clotting off. do not miss or stop taking plavix for one month unless dr. tells you to. 2. decrease your aspirin to 81 mg daily 3. start taking calcium with vitamin d to prevent bone loss 4. start pantoprazole twice daily to prevent further stomach bleeding 5. start lidocaine patch to painful back area once daily 6. start mirtazipine 15 mg at night to help your mood and your appetite. this will probably need to be increased by dr. . 8. take senna up to twice daily to prevent constipation 9. take ciprofloxacin for 3 days to treat your urinary tract infection . weigh yourself every morning, md if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. followup instructions: please follow up with the following providers: cardiology and primary care: provider: , phone: date/time: friday at 11:30am. . gastroenterology: , , md , phone: fax: date: at 10:15pm. procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters angiocardiography of left heart structures injection or infusion of platelet inhibitor left heart cardiac catheterization excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel insertion of three vascular stents procedure on vessel bifurcation diagnoses: other iatrogenic hypotension other chronic pain coronary atherosclerosis of native coronary artery congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified hematoma complicating a procedure personal history of tobacco use depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status urinary frequency blood in stool acute myocardial infarction of other inferior wall, initial episode of care cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure chronic systolic heart failure pain in joint, pelvic region and thigh nontraumatic hematoma of soft tissue anticoagulants causing adverse effects in therapeutic use backache, unspecified arthrodesis status personal history of traumatic fracture 

Answer: The patient is high likely exposed to