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: history of present illness: the patient was originally admitted to the vascular surgery service and was then transferred three to four days later to the c-med service. this is a 73-year old female with coronary artery disease (status post coronary artery bypass grafting and multiple cardiac catheterizations and percutaneous interventions at outside hospitals), peripheral vascular disease, chronic renal insufficiency, and insulin-dependent diabetes mellitus who was transferred to from an outside hospital to the vascular surgery service with a right lower extremity gangrenous ulceration. the reason for transfer was for possible vascular intervention. on arrival to the vascular surgery service the patient's inr was elevated as she had been on coumadin for atrial fibrillation. she was given two units of fresh frozen plasma to reverse her coagulopathy and developed jaw pain (her anginal equivalent) and went into acute cardiogenic pulmonary edema. the patient was nearly intubated but improved with a nitroglycerin drip and natrecor. she was then transferred to the c-med service for further diuresis and because her exercise tolerance test sestamibi obtained following her acute cardiogenic pulmonary edema showed reversible anterior defects as well as partially reversible lateral wall defects. her creatine kinase and troponin were flat at the time of the acute cardiogenic pulmonary edema. the patient did report some baseline shortness of breath, but felt that it was worse at the time of transfer to c-med service. however, at baseline the patient can only walk 15 feet with a walker and is limited by anginal pain or shortness of breath. the patient did report paroxysmal nocturnal dyspnea, orthopnea, and lower extremity edema in the past - but not currently. the patient uses 2 liters of oxygen at home. past medical history: diabetes mellitus. coronary artery disease; status post coronary artery bypass grafting and multiple percutaneous coronary interventions. chronic renal insufficiency. peripheral vascular disease; status post lower extremity interventions. history of deep venous thrombosis with filter placement. congestive heart failure with an ejection fraction of 35 percent. parkinson disease. anemia of chronic disease. atrial fibrillation (on amiodarone and coumadin). gout. gastroesophageal reflux disease. depression. polymyalgia rheumatica. status post cholecystectomy. medications on transfer to the c-med service: 1. mucomyst 600 mg twice per day. 2. allopurinol 100 mg once per day 3. albuterol as needed. 4. aspirin 81 mg once per day. 5. amiodarone 20 mg once per day. 6. wellbutrin 25 mg once per day 7. famotidine 20 mg twice per day. 8. subcutaneous heparin. 9. heparin drip. 10. insulin sliding scale and nph insulin. 11. lactulose. 12. vancomycin. 13. simvastatin. 14. ropinerole 0.25 four times per day. 15. prednisone 5 mg once per day. 16. nitroglycerin drip. 17. nitroglycerin patch. 18. toprol 25 mg once per day. 19. levaquin 250 once per day. 20. synthroid 50 mcg once per day. social history: the patient is widowed and has two daughters. she does not smoke or drink. physical examination on presentation: vital signs revealed a temperature of 99.2, heart rate was 69 (range 60 to 69), blood pressure was 147/35 (range 120 to 141/29 to 63), and 98 percent on 4 liters. in general, the patient was a chronically ill-appearing elderly female sitting upright in mild respiratory distress. head, eyes, ears, nose, and throat examination the pupils were equal, round, and reactive to light. the extraocular movements were intact. the moist mucous membranes. neck revealed jugular venous pressure approximately 14 but difficult to assess given the patient's neck pannus. cardiovascular examination revealed a regular rate and rhythm. a 2/6 systolic murmur at the left upper sternal border. lungs with bibasilar rales halfway up. the abdomen was obese, slightly distended, left-sided scar, and nontender. extremities revealed trace edema of right and left foot. pertinent laboratory values on presentation: significant for a hematocrit of 31.8, inr of 1.5, a partial thromboplastin time of 58.8, and creatinine of 1.4. pertinent radiology-imaging: the patient's previous catheterization in at the showed saphenous vein graft to left anterior descending patent, and saphenous vein graft to posterior descending artery patent, skip graft to the obtuse marginal from the posterior descending artery which was occluded. the left circumflex was totally occluded with collaterals. the right coronary artery with 95 percent tubular stenosis. no intervention was done at this last previous catheterization in . summary of hospital course: 1. congestive heart failure issues: the patient was transferred to the c-med service and initiated on natrecor as well as intravenous lasix. the patient's volume status throughout her hospital course was difficult to evaluate given her lack of neck veins; however, her lungs had shown evidence of volume overload as did her chest x-ray. the patient did respond with much diuresis with the natrecor. an ace inhibitor was initiated as the patient had not been on it previously and a low ejection fraction. the following day - after two doses of captopril and continuing the natrecor - the patient developed acute-on-chronic renal failure with a creatinine that bumped to 2 and hypotension which responded to a 250-cc normal saline bolus. her captopril was held, and the patient's blood pressure stabilized. the following day the patient was transferred to the coronary intensive care unit for possible swan-ganz catheter placement. as the patient's respiratory status had appeared to become depressed, and secondary to increased creatinine, the diuresis was not going well. in the coronary care unit the natrecor was restarted. a nitroglycerin drip was also initiated. the patient did not further diurese but did improve respiratory wise and was called back out to the c-med service floor. the patient was continued on natrecor and was also tried on lasix as well as bumex and zaroxolyn. the patient did respond somewhat to the zaroxolyn and lasix combination, but her sodium subsequently dropped from 130 to 125 two days status post zaroxolyn, and this was again held. the patient did again have a further episode of what appeared to be acute cardiogenic pulmonary edema on which responded to nitroglycerin, morphine, and hydralazine, as well as the natrecor which was already present. during all of these episodes the patient was very hypertensive, and it was thought that impaired filling was causing the acute decompensation. the patient's creatinine did improve enough that she was able to go for a cardiac catheterization. the cardiac catheterization also had a right heart catheterization which was performed to the neck secondary to the filter. the pulmonary capillary wedge pressure was 24, and her right atrial pressure was 12 during that catheterization. following this cardiac catheterization, the patient was back to the floor and the plan was to further diurese her because her lungs still sounded wet. however, the patient was not responding to the natrecor and lasix - and the problems mentioned above of electrolytes occurring with the zaroxolyn also began to complicate matters. the patient seemed very hyponatremic on ; probably either from over diuresis or from worsening heart failure and hypovolemic hyponatremia. on , the patient had an episode of extreme hypotension and severe respiratory distress which was again thought to be acute cardiogenic pulmonary edema. again, the patient had not been significantly diuresed even since admission. during this acute decompensation required intubation and was transferred to the coronary care unit on . 1. ischemia issues: the patient did have several episodes of anginal pain with occasional small troponin leaks of up to 0.19. the cardiac catheterization demonstrated distal 20 percent left main coronary artery, patent high diagonal in the left anterior descending, but left anterior descending occluded after the diagonal origin, the left circumflex with ostial stem with 30 percent in-stent restenosis, him obtuse marginal occluded, lpl 50 percent, and right coronary artery with ostial 50 percent, mid 80 percent, and then total occlusion. the saphenous vein graft to left anterior descending showed mild plaquing, and the mid left anterior descending filling retrograde with moderate- to-severe diffuse disease. the saphenous vein graft to posterior descending artery was patent, but the segment to the obtuse marginal was occluded. given the patent stents and vein grafts, no intervention was done at the time. the patient was continued on her aspirin, statin, and beta blocker. 1. rhythm issues: the patient has a history of paroxysmal atrial fibrillation. she remained on a heparin drip but was intermittently transitioned to lovenox in an attempt to cut down on her fluid intake. she was then switched to a heparin drip on transfer back to the coronary care unit the second time. the patient was also continued on her amiodarone dose. she was thought to go into atrial fibrillation during her final episode of acute cardiogenic pulmonary edema, but then converted back to a sinus rhythm after transfer to the coronary care unit. 1. peripheral vascular disease issues: the patient had bilateral foot ulcerations; right greater than left. they was thought to be dry gangrene. the vascular surgery team followed and did debride the wound once during this hospitalization. the patient's wound had grown methicillin-resistant staphylococcus aureus at an outside hospital. thus, the patient was continued on vancomycin (renally dosed). she was initially of levaquin on transfer from the hospital, and this was continued but then discontinued when the culture data was followed up on. the overall plan was for the patient to go for an angiogram of her bilateral lower extremity so that the possibility for intervention could be assessed. at the time of this dictation, the patient had still had not become stable enough or have an appropriate creatinine to tolerate the angiogram, and this was postponed for this reason. 1. chronic renal insufficiency issues: the patient's creatinine went from approximately 1.3 to 2.5 during her hospital course. it remained mostly in the 1.3 to 1.6 range. medications were renally dosed, and the chronic renal insufficiency made diuresis very limited. on transfer to the coronary care unit a workup was begun for renal artery stenosis, and this was in progress at the time of this dictation. 1. diabetes issues: the patient was continued on her nph dose and regular insulin. she was significantly hyperglycemic during her admission. 1. parkinson disease issues: the patient was continued on her ropinirole. 1. hematologic issues: the patient did have an anemia of chronic disease, and her hematocrit drifted down during her hospital admission. she did require one unit of blood which she tolerated well, with lasix following the transfusion. the patient's hematocrit then remained stable at around 30. this discharge summary covers the admission up until . the rest of the dictation will be dictated by the coronary care unit intern. , procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube excisional debridement of wound, infection, or burn transfusion of other serum injection or infusion of nesiritide diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia coronary atherosclerosis of autologous vein bypass graft atrial fibrillation atherosclerosis of native arteries of the extremities with gangrene 

Answer: The patient is high likely exposed to