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: bactrim attending: chief complaint: shortness of breath major surgical or invasive procedure: cardiac catheterization history of present illness: ms is a 71 year old woman with history of insulin dependent diabetes, peripheral disease, hyperthyroidism and cad, s/p recent stemi, s/p cabg x 4 in (lima to lad, svg to om1, om2 and rca), s/p left ventricular aneurysm repair, presenting with shortness for the last four days. . patient repors she has been feeling short of breath with normal daily activities (making her bed, going to the kitchen) that was new. she also describes rhinorrhea, watery eyes and a dry cough. she presented to her pcp with these complaints and she was empirically treated for a community acquired pneumonia. cardiac enzymes were also drawn and patient was called to present to ed after these returned elevated (per report 1.5, unclear if tn t or i). . patient denies any chest pain, nausea, vomiting, dizziness, light headedness, palpitations, syncope or pre-syncope. she does point out however that she has never had symptoms with any of her heart attacks but rather that these present with uri symptoms. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism. she does report excessive bleeding previously after a cardiac cath performed at complicated by rp bleed. no excessive bleeding after recent bypass however. denies any hemoptysis, black stools or red stools. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, but does report chronic bilateral ankle edema. denies palpitations, syncope or presyncope. . in the ed, vs 97.1, bp 140/84, hr 108, rr24. patient given asa, bb, and started on iv heparin. admitted for further evaluation. past medical history: - mi in c/b ventricular aneurysm - cabg: in x4 lima to lad, svg to om1, svg to om2, svg to rca, lcx endarterectomy - s/p left ventricular aneurysm repair (dor procedure?) past medical history: -- pad s/p left sfa angioplasty and stent -- dm2 -- htn -- oa -- spinal stenosis -- hyperthyroidism -- s/p cholecystectomy -- s/p appendectomy -- s/p tah . cardiac risk factors: (+) diabetes, (+) dyslipidemia, (+)hypertension social history: lives with her husband in , is np and is very involved in her care. denies tobacco, etoh family history: no family history of early mi, otherwise non-contributory. physical exam: vs: 97.9 112/70 83 18 98% 2l nc general: anxious elderly woman in nad. oriented x3. 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 16 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, distant heart sounds with normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c, 3+ bilateral lower extremity edema. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: ekg: () nsr at 87 with incomplete right bundle branch block, twi at avl, i and v2, with 1mm st elevation in v2-v3. . 2d-echocardiogram: () the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed (lvef= 20-30 %) secondary to severe hypokinesis of the anterior septum and anterior free wall, with extensive apical akinesis and focal apical dyskinesis (no definite apical thrombus seen but cannot exclude with certainty). there is no ventricular septal defect. right ventricular chamber size is normal. with focal hypokinesis of the apical free wall. the aortic arch is mildly dilated. there are focal calcifications in the aortic arch. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the left ventricular ejection fraction is further depressed, secondary to extensive hypokinesis of the anterior septum and anterior free wall. . ett: () ramping cycle ergometer protocol, 3 mins interpretation: this 71 yo woman (h/o silent nstemi and s/p cabg on ) was referrred to the lab for evaluation. the patient completed 3.75 minutes on a ramping cycle ergometer protocol and was stopped due to marked shortness of breath and fatigue. this represents a limited exercise tolerance for her age (~ 3.5 mets). the patient denied any neck, chest, arm or back discomfort throughout the study. no significant st segment changes were noted from baseline. the rhythm was sinus with one single vpb noted in recovery. appropriate increased in blood pressure noted with exercise. blunted heart rate response to exercise in the presence of beta-blockade therapy. impression: marked shortness of breath noted at a low workload. no ischemic ekg changes noted. . cardiac cath: () final diagnosis: 1. three vessel coronary artery disease. 2. severe systolic ventricular dysfunction. 3. occluded svg-om venous conduits 4. moderate mitral regurgitation. . cardiac cath: () final diagnosis: 1. three vessel coronary artery disease. 2. successful placement of an iabp via the left femoral artery. 3. successful ptca and stenting of the left main - proximal left circumflex with a xience drug eluting stent. 4. successful ptca of the proximal left anterior descending artery. . chest x-ray: personal review demonstrates partially rotated film with blunted left costophrenic angle and right lower lobe opacity, with minimal change from prior in (with exception of left sublavian line which not present now). . renal ultrasound: bilateral simple renal cysts. otherwise normal renal ultrasound. . labs: 01:30am wbc-9.8 rbc-4.08* hgb-11.9* hct-35.5* mcv-87 mch-29.1 mchc-33.5 rdw-15.3 01:30am neuts-82.6* lymphs-10.2* monos-3.5 eos-3.4 basos-0.3 01:30am plt count-216 01:30am ck(cpk)-117 01:30am ctropnt-0.44* 01:30am ck-mb-11* mb indx-9.4* 09:15am ck(cpk)-140 09:15am ck-mb-13* mb indx-9.3* ctropnt-0.47* 05:25pm ck(cpk)-143* 05:25pm ck-mb-12* mb indx-8.4* ctropnt-0.49* brief hospital course: 71 year old woman with insulin dependent diabetes, 3 vessel cad s/p cabg, presenting with dyspnea and nstemi found to have occlusion of 3 of 4 by-pass grafts now s/p lcx stenting and ptca of the lad now transferred to the ccu with iabp. . # acs/ nstemi: initial cardiac catherization showed restenosis of bypass grafts (except svg-rca) not felt to be repeat surgical candidate and thus underwent lcx stenting and ptca to lad. she had an intra-aortic baloon pump placed overnight and was transferred to the ccu. there her balloon pump was weaned easily over the first day. medical management of cad including heparin gtt, plavix, asa, statin were continued. . # acute systolic heart failure: admitted with systolic heart failure and s/p diuresis with lasix gtt. patient improved after diuresis and was without dyspnea. acei and beta blocker were continued. in the ccu, no further diuresis was required. she was evaluated by pt and her ambulatory o2 sats were 93% on room air. . # rhythm: she remained in normal sinus rhythm. . # diabetes: her insulin regimen was uptitrated to improve blood sugar control. . # hyperthyroidism: tsh was normal; methimazole was continued medications on admission: asa 325mg lipitor 80mg lisinopril 10mg metoprolol 50mg plavix protonix tapazole 10mg insulin -- levemir 34 units at night -- humalog 8 with breakfast, 14 with dinner. clorazepate 3.75 mg qday discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. methimazole 10 mg tablet sig: one (1) tablet po daily (daily). 7. levemir 100 unit/ml solution sig: forty two (42) units subcutaneous at bedtime. 8. humalog 100 unit/ml cartridge sig: as directed subcutaneous twice a day: please take 4 units before breakfast and 10 units before dinner. . 9. clorazepate dipotassium 3.75 mg tablet sig: one (1) tablet po daily (daily) as needed for anxiety. 10. toprol xl 50 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po once a day. disp:*45 tablet sustained release 24 hr(s)* refills:*2* 11. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: nstemi systolic heart failure, acute on chronic secondary issues: peripheral disease hypertension hypothyroidism osteoarthritis spinal stenosis discharge condition: stable. ambulating without assistance. breathing comfortably on room air. discharge instructions: you were admitted with shortness of breath. you were found to have a small heart attack (nstemi). you were treated with medications to prevent further damage to your heart. you underwent cardiac catheterization and found to have blockages in multiple arteries including the grafts that were created during your recent cabg. your heart function was evaluated and you were found to have slightly worse heart function. you were given medications to remove excess fluid from your body. you had a second catheterization and had stents placed in some of your blocked arteries. please keep all of your follow-up appointments. please continue your medications as prescribed. we made the following changes to your medicaiton regimen. 1. we increased the dose of your toprolol. please take toprolol xl 50 mg tablets, take 1.5 tablets by mouth daily 2. we decreased the dose of your lisinopril. please take lisinopril 5 mg daily instead of 10 mg daily. 3. we increased the dose of your levemir to 42 units at bedtime. we decreased the dose of your humalog to 4 units before breakfast and 10 units before dinner. please check your blood sugars before breakfast and before dinner. please contact your doctor or go to the emergency room if you experience any of the following symptoms: chest pain or pressure, worsening shortness of breath, difficulty breathing with minimal exertion, lightheadedness/dizziness or other concerning symtpoms. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: none followup instructions: we recommend that you follow up with your cardiologist, dr. , next week. we have made an appointment for you on monday, at 2:45pm in the office. the office phone number is ( if you have questions. please make an appointment to follow up with your diabetes doctor in the next 1-2 weeks to follow up on your blood sugar control. please make an appointment to see your primary care physcian, dr , in the next 1-2 weeks. his telephone number is . you had the following appointments scheduled previously: provider: lab phone: date/time: 11:00 provider: , md phone: date/time: 11:30 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 other and unspecified coronary arteriography implant of pulsation balloon right heart cardiac catheterization cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled coronary atherosclerosis of autologous vein bypass graft acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to