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: chest tightness, syncope major surgical or invasive procedure: bare metal stent placement x3 to rca history of present illness: 88f with hx of htn and angina who presents with acute chest pain. pt states that she has had two prior episodes of chest pain, both occurring at night, never with exertion. she was recently prescribed sl ntg by her cardiologists. pt states that today, she was playing cards when she experienced chest tightness. she took 2 sl ntg which relieved the pain but after taking the ntg, she had an episode of syncope while sitting. she awoke within seconds and was asymptomatic, no nausea or diaphoresis. ems was called and registered a bp of 70/30, hr of 50s and she was brought to the er. . while in the er, pt experienced chest pain once again, worse than prior, associated with diaphoresis. she went into a junctional brady rhythm at 36 bpm x few minutes, followed by an irregular bradycardia at 50 bpm with no obvious atrial activity. this resolved on its own without intervention and heart rate and bp normalized. cardiology was consulted due to concern for complete heart block. . pt was then sent to the floor where she again experienced chest pain associated with bradycardia and hypotension. on ekg, while bradycardic, she developed st elevations in leads 2,3,avf, sbp in the 70s. she received no medications due to the bp in the 70s and then she returned to sinus rhythm with improvement in her bp to the 100s. . given the st elevations, the cath was activated. she was loaded with 600mg of plavix and integrillin gtt was started. cath showed 50-60% mid-rca, 90% mid-lad and 20% lcx. pt remained asx during procedure but no lesions were stented and plan was to stress in am. however, while pt was still on table, she again developed 10/10 chest pain and became bradycardic to the 50s with st elevations. they reinitiated the procedure with goal of stenting the rca. when the wire was in the rca, there was loss of flow in the rca leading to hypotension, bradycardia and chest pain. she was started on max dose dopamine and the artery went into severe vasospasms. she was then started on fluids, iv ntg along with ic ntg, atropine and a pacer wire was placed. following reinitiation of flow in the rca, 3 bare metal stents were placed. the dopa was weaned. she was then in atrial fibrillation with a rate in the 140s. she was given two doses of adenosine but remained in afib. she then received ic diltiazem which converted her into sinus. . on arrival to the ccu, pt complains of low back pain but no chest pain past medical history: htn hypothyroidism stroke 2.5 years ago, no residual deficit gerd no known h/o cad, dm angina, increasing in severity . cardiac risk factors: hypertension social history: social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: blood pressure was 126/66mm hg while lying flat. pulse was 86beats/min and regular, respiratory rate was 19breaths/min, satting 100% on 3l nc. generally the patient was well developed, well nourished and well groomed. the patient was oriented to person, place and time. the patient's mood and affect were not inappropriate. . there was no xanthalesma and conjunctiva were pink with no pallor or cyanosis of the oral mucosa. the neck was supple with jvp of 12cm. the carotid waveform was normal. there was no thyromegaly. the were no chest wall deformities, scoliosis or kyphosis. the respirations were not labored and there were no use of accessory muscles. the lungs were clear to ascultation bilaterally with normal breath sounds and no adventitial sounds or rubs. . palpation of the heart revealed the pmi was not palpable there were no thrills, lifts or palpable s3 or s4. the heart sounds revealed a normal s1 and the s2 was normal. there were no rubs, clicks or gallops heard; murmur at llsb . the abdominal aorta was not enlarged by palpation. there was no hepatosplenomegaly or tenderness. the abdomen was soft nontender and nondistended. the extremities had no pallor, cyanosis, clubbing or edema and were warm. there were no abdominal, femoral or carotid bruits. inspection and/or palpation of skin and subcutaneous tissue showed no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ pertinent results: ekg during vasospasm sinus brady at 32 with extreme prolonged pr; normal axis; 2mmst elevations in ii and 3mm st elevations in iii and avf with receiprocal changes in i, l, v2, v3 . ekg after cath demonstrated afib at 92bpm, nl axis, no acute st changes . 2d-echocardiogram: none on file . cardiac cath performed on demonstrated: final diagnosis: 1. two vessel coronary artery disease. 2. temporary pacemaker placement due to bradycardia. 3. severe vasospasm of the mid rca with moderate plaques. 4. successful pci of the mid and distal rca with bare metal stents. . 04:50pm wbc-8.2 rbc-3.45* hgb-11.1* hct-32.6* mcv-95 mch-32.2* mchc-34.1 rdw-13.8 04:50pm glucose-120* urea n-30* creat-0.9 sodium-137 potassium-3.5 chloride-104 total co2-23 anion gap-14 troponin: neg - neg - 0.05 (peak) - trending down thereafter brief hospital course: 88f with hx of htn who presented with chest pain, syncope, vagal episodes and inferior st elevations, now s/p cardiac cath with bms x3 to rca, monitored in the ccu. patient did not have anymore episodes of chest pain and recovered quickly without any complications. . 1. ischemia: patient had st elevations (inferior leads with iii > ii) in the cath in the setting of active chest pain. theory is that pt was experiencing chest pain from ulcerated 60% rca lesion leading to ischemia, inferior st changes and a profound vagal episode leading to transient chb and hypotension. now s/p bms x 3 to rca. enzymes were cycled and troponin peaked at 0.05, trending down thereafter. she was given lipitor 80mg, asa and plavix. integrillin was discontinued due to bleeding from her groin post cath. she was not started on a beta blocker due to av block. she has a follow-up appointment with her primary cardiologist on . 2. rhythm: patient had evidence of complete heart block and profound vagal tone leading to bradycardia to the 30s when ischemic during cath. a temporary pacing wire was placed. however, following her bradycardia she remained in nsr with rate 60s-70s and the pacing wire was pulled. she was evaluated by ep to determine whether she would benefit from pacemaker. she also had a brief episode of atrial fibrillation following several doses of atropine in cath , thereafter back in nsr (no hx of afib). bb and ccb were held and not continued after discharge. coumadin (for h/o cva) was also held initially for possible procedures. she was not started on a beta blocker due to pr prolongation. coumadin was restarted prior to discharge. an inr should be checked two days after discharge. . 3. chf: ventriculogram in cath showed normal ef of 60%. she was given 10mg iv lasix for gentle diuresis post-cath due to elevated lvedp of 23. on arrival to the ccu she appeared euvolemic and no further diuresis was necessary. . 4. hypertension: patient had hypotensive episodes as described above. her ccb and avapro were held throughout the hospital stay. her bp was well controlled off these medications. her avapro should likely be restarted as an outpatient. her ccb should be held given a pr prolongation. she has a follow-up appointment with her primary cardiologist on . . 5. s/p cva: 2 1/2 years ago; no remaining deficits per patient; due to "clot from the heart" per patient. but per pt, she had never been diagnosed with atrial fibrillation. she has been on coumadin since the stroke which was transiently held for possible procedures like a pacemaker placement. her coumadin has been restarted upon discharge. . 6. anemia: unclear baseline; type and screen was active. hct remained stable and was 28.6 on discharge. . 7. hypothyroidism: continued levoxyl . 8. fen: initially npo for possible procedure, then on cardiac diet . 9. access: sheath in right groin (pulled ), piv . 10. communication: son, dr (pulmonary at ) . 11. code: presumed full medications on admission: asa 81mg 3x/week norvasc 10 avapro 300 lipitor 20 levoxyl .05 lasix 20 coumadin discharge medications: 1. aspirin 325 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* 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. levothyroxine 25 mcg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 5. warfarin 5 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnosis: 1. inferior st elevation mi, s/p 3x bms placement to rca 2. two-vessel cad, s/p stenting of rca 3. vagal reaction with hypotension and transient complete heart block 4. brief episode of atrial fibrillation during cardiac catheterization . secondary diagnosis: 1. s/p cva, on coumadin 2. chronic anemia 3. hypothyroidism discharge condition: free of chest pain. afebrile. hemodynamically stable. ambulating. tolerating po. discharge instructions: you have been admitted for chest pain. you were found to have lesions in your coronary arteries. one artery has been kept open with three stents. your heart rhythm was abnormal so that your blood pressure medications had to be held. you have been started on a medication called plavix for your stent. . your coumadin has been held transiently during your hospital stay. you have been restarted on your regular coumadin dose prior to discharge. you should have an inr checked two days after discharge at your regular coumadin clinic / pcp's office. . please call your primary doctor or return to the ed with fever, chills, chest pain, shortness of breath, dizziness, near-fainting, nausea/vomiting, spontaneous bleeding or any other concerning symptoms. . please take all your medications as directed. . please keep you follow up appointments as below. followup instructions: please follow up with your primary care doctor (dr. - affiliated with ) in weeks from now. . please also follow up with your cardiologist dr. from the lown group. an appointment has been scheduled for you: wed at 1pm (phone: ). . your blood pressure medications have been held. your cardiologist will decide if you can be restarted on any of them. 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 insertion of temporary transvenous pacemaker system excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] insertion of three vascular stents procedure on two vessels diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension unspecified acquired hypothyroidism cardiac complications, not elsewhere classified atrial fibrillation other specified cardiac dysrhythmias atrioventricular block, complete acute myocardial infarction of other inferior wall, initial episode of care unspecified late effects of cerebrovascular disease 

Answer: The patient is high likely exposed to