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: morphine / iv dye, iodine containing contrast media attending: chief complaint: hypotension during catheterisation major surgical or invasive procedure: cardiac catheterization history of present illness: ms. is a 56 year-old woman with a history of cad s/p nstemi and pci with stenting of the rca in who presented today for elective cardiac catheterization with procedure complicated by hypotension and bradycardia. . patient with c/o in the cath lab, her stents appeared to be patent. however, after angiography, the patient became hypotensive to the 60s systolic with bradycardia and ?heart block. she was given 1 mg atropine with no effect, and dopamine was started. during this time, she complained of chest pain and was noted to have transient anterolateral st elevation, concerning for new ischemia. however, the vessels were again visualized angiographically and remained patent. . on dopamine and 1.5 l ivns, her blood pressure improved and remained in the 90s with hr 80s. swan was placed and demonstrated low filling pressures and high cardiac output, concerning for either a vagal reaction or contrast allergy causing peripheral vasodilatation. tte was also performed and showed a hyperdynamic heart. she received solumedrol, pepcid, and benadryl. arterial and venous sheaths were placed in the groin. with systolic pressures in the 90s on 7.5 of dopamine, she was transferred to the ccu. . with regard to her recent cardiac history, she has known cad s/p nstemi and pci and stenting of the rca in . she noted feeling occasional exertional left shoulder pain accompanied by shortness of breath in . she reported her symptoms to her cardiologist and underwent a nuclear stress test in . she exercised for 8 minutes of a standard protocol. during exercise minimal st depressions in v4-v6 were non-diagnostic for ischemia. imaging revealed mixed, mild, persistent, and stress induced myocardial ischemia in the apical lateral wall of the lv. fixed, mild, persistently decreased myocardial perfusion in the apical septal wall of the lv was also noted. lvef was 75%. no significant regional wall motion abnormality was present in the lv. . on evaluation by the ccu team, the patient's only complaint was that she felt cold. she denied chest pain, light-headedness, dizziness. review of systems was otherwise negative. . past medical history: 1. cardiac risk factors: -diabetes, +dyslipidemia, +hypertension 2. cardiac history: - cad s/p nstemi - cabg: none - percutaneous coronary interventions: s/p pci of rca - initial dilatation with 2.0mm x 15mm maverick followed by 3.0mm x 16mm taxus des and post dilatation at mid and proximal portions of the stent with 3.5mm x 8mm maverick - pacing/icd: none 3. other past medical history: - gerd - anxiety - depression - tonsillectomy as a child social history: married and living with her family in , ma. - tobacco history: denies use, quit in . - etoh: denies use. - illicit drugs: none. family history: her brother died of an mi at age 38. both parents had cabg and are deceased. her mother had diabetes. her sister had an mi at age 43. physical exam: on admission: general: nad. mildly sedated, oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. . neck: supple without jvd cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. anterior fields were 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/e. groin: fem arterial and venous sheath in place; minimal tenderness, no visible hematoma or oozing. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ . on discharge: eneral: nad. alert oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. mild facial flushing. neck: supple without jvd cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: 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/e. groin: fem arterial and venous sheath in place; minimal tenderness, no visible hematoma or oozing. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ dp 2+ pt 2+ pertinent results: labs: 03:20pm blood wbc-9.1 rbc-3.93* hgb-12.4 hct-34.9* mcv-89 mch-31.6 mchc-35.6* rdw-12.9 plt ct-281 04:00am blood wbc-8.8 rbc-3.79* hgb-12.0 hct-34.2* mcv-90 mch-31.8 mchc-35.2* rdw-13.0 plt ct-301 03:20pm blood glucose-137* urean-12 creat-0.8 na-138 k-3.7 cl-107 hco3-23 angap-12 04:00am blood glucose-134* urean-21* creat-0.9 na-140 k-4.5 cl-109* hco3-21* angap-15 . biomarkers: 03:20pm blood ck-mb-3 ctropnt-<0.01 08:30pm blood ck-mb-2 ctropnt-<0.01 03:20pm blood ck(cpk)-72 08:30pm blood ck(cpk)-67 . tte: overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. there is no pericardial effusion. impression: normal left ventricular ejection fraction. no pericardial effusion or tamponade physiology seen. . cardiac cath brief history: this 56 year old woman with a history of atypical chest pain underwent a stress test that demonstrated an apical-lateral reversible defect on nuclear imaging. indications for catheterization: procedure: coronary angiography was performed via a radial approach, using a 5 fr jacky catheter to engage both coronary ostia. the procedure was complicated by hypotension and bradycardia, which occured follwoing exchange of catheters for an xblad 3.5 guide. the patient required 1mg iv atropine, dopamine infusion as well as 2l iv fluid for restoration of normotension. during the hypotensive episode femoral arterial and venous access was emergently obtained. conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. hemodynamics results body surface area: 1.8 m2 hemoglobin: 12.8 gms % fick **pressures right atrium {a/v/m} 11/9/9 right ventricle {s/ed} 35/9 pulmonary artery {s/d/m} 35/14/21 pulmonary wedge {a/v/m} 17/12/14 aorta {s/d/m} 82/46/60 **cardiac output heart rate {beats/min} 97 rhythm s o2 cons. ind {ml/min/m2} 125 a-v o2 difference {ml/ltr} 23 card. op/ind fick {l/mn/m2} 9.8/5.4 **resistances systemic vasc. resistance 416 pulmonary vasc. resistance 57 **% saturation data (nl) pa main 86 ao 100 technical factors: total time (lidocaine to test complete) = 0 hour105 minutes. arterial time = 0 hour103 minutes. fluoro time = 21.3\ minutes. irp dose = 857 mgy. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 140 ml premedications: midazolam 4 mg iv fentanyl - mcg anesthesia: 1% lidocaine subq. anticoagulation: heparin 4000 units iv other medication: dopamine 7.5 mcg/kg/min infusion nitroglyceirn 200mcg ia solu-medrol 80 mg iv verapamil 2.5mg ia diphenhydramine 25mg iv cardiac cath supplies used: 5fr cordis, xb 3.5 5fr cordis, xblad 3.5 5fr cordis, jr4 introducer guide - allegiance, custom sterile pack - merit, left heart kit - merit, right heart kit 5fr terumo, jacky radial catheter 5fr terumo, jacky radial catheter 5fr arrow, transradial artery access kit - , priority pack 20/30 5fr arrow, balloon wedge pressure catheter 110cm - terumo, tr band large comments: 1. selective coronary angigoraphy in this right dominant system demonstrates two vessel coronary disease. the left anterior descending contains a 50% eccentric stenosis in the mid-lad. there was a separate 50% stenosis of the first diagonal. the right coronary artery has a 40% instent restenosis and only minor irregularites of the circumflex artery. 2. the case was complicated by hypotension and bradycardia severe enought to require dopamine infusion. hemodynamics during this episde demonstrate a normal/hyperdynamic ventricle with peripheral vasodilation. final diagnosis: 1. two vessel coronary artery disease. 2. hypotension/bradycardia, with hemodynamics consistent with vasodilatation complicating the case. brief hospital course: ms is a 56 year old female with h/o cad s/p des to rca in transferred to the ccu after elective cardiac catheterization due to procedure complication of hypotension and bradycardia thought secondary to atypical contrast reaction. . # hypotension/bradycardia. during elective cardiac catheterization patient developed hypotension and bradycardia, which occured following exchange of catheters for an xblad 3.5 guide. the patient required 1mg iv atropine, dopamine infusion as well as 2l iv fluid for restoration of normotension. differential diagnosis for constellation of cardiac findings included increased vagal tone, atypical reaction secondary to medication/contrast, ischemia with heart block, bleed. after review of ekg (no signs of block) and labs (biomarkers negative, hct stable), surmised that episode secondary to atypical contrast reaction with component of increased vagal tone. during the cardiac cath patient received atropine x1, and started on dopamine. for treatment of suspected allergic reation patient given iv solumedrol, pepcid, benadryl for treatment of possible atypical contrast reaction. patient transferred to the ccu for monitoring. dopamine weaned off within hours of arrival to ccu. anti-hypertensives were initially held. pressures remained stable overnight and patient without complaint prior to discharge. home atenolol and valsartan restarted prior to discharge. contrast added to medication allergies/interactions. . # cad. patient with h/o stemi s/p des to rca in . history of atypical chest pain and stress test that demonstrated an apical-lateral reversible defect on nuclear imaging prompted elective cardiac catheterization on . cardiac cath demonstrated 1. selective coronary angigoraphy in this right dominant system demonstrates two vessel coronary disease. the left anterior descending contains a 50% eccentric stenosis in the mid-lad. there was a separate 50% stenosis of the first diagonal. the right coronary artery has a 40% instent restenosis and only minor irregularites of the circumflex artery. 2. the case was complicated by hypotension and bradycardia severe enought to require dopamine infusion. hemodynamics during this episde demonstrate a normal/hyperdynamic ventricle with peripheral vasodilation. patient developed pressure-like chest pain in setting of hypotension which was reliefed with initiation of dopamine. post-procedure tte left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. biomarkers negative. at time of discharge patient on aspirin (dose decreased from 325->81mg), plavix, crestor, and bb daily. outpatient issues: -- continued discussion regarding need of cardiac rehab . # rhythm. patient monitored on telemetry. patient with episode of sinus brady during the cardiac catheterization that responded to atropine x1. patient monitored on telemetry post-procedure and remained in normal sinus rhythm with rates in 60s-80s throughout remainder of stay. . # htn. episode of hypotension in the cardiac catheterization resolved with supportive care of ivf and short course of dopamine. blood pressures stabilized prior to discharge and home anti-hypertensives restarted. . # hld. continued on home crestor . # anxiety/depression. held home ativan, cymbalta, ambien in acute setting. medication regimen restarted prior to discharge. medications on admission: prescription - atenolol 50 mg tablet - 1 tablet(s) by mouth once daily - clopidogrel 75 mg tablet - 1 tablet(s) by mouth once daily - duloxetine 30 mg capsule, delayed release(e.c.) - 3 capsule(s) by mouth once daily - estradiol - 10 mcg tablet - twice per week - lorazepam - 1 mg tablet - 1 tablet(s) by mouth once daily or as needed - pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once daily - rosuvastatin - 40 mg tablet - 1 tablet(s) by mouth once daily - valsartan - 80 mg tablet - 1 tablet(s) by mouth once daily - zolpidem - 10 mg tablet - 1 tablet(s) by mouth once daily . otc - aspirin - 325 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once daily - ergocalciferol (vitamin d2) - 400 unit capsule - 2 capsule(s) by mouth once daily discharge medications: 1. valsartan 40 mg tablet sig: two (2) tablet po daily (daily). 2. atenolol 25 mg tablet sig: two (2) tablet po daily (daily). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. rosuvastatin 20 mg tablet sig: two (2) tablet po daily (daily). 6. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 7. zolpidem 10 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. lorazepam 1 mg tablet sig: one (1) tablet po once a day as needed for anxiety/insomnia. 10. cymbalta 30 mg capsule, delayed release(e.c.) sig: three (3) capsule, delayed release(e.c.) po once a day. 11. vagifem 10 mcg tablet sig: one (1) vaginal twice weekly. discharge disposition: home discharge diagnosis: primary hypotension/bradycardia in setting of contrast reaction coronary artery disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms it was a pleasure taking care of you. . you were admitted to the ccu after you developed a slow heart rate and low blood pressure during your cardiac catheterization. though this episode was ambigious it was thought secondary to an atypical allergic reaction to the contrast dye. you were monitored closely and your blood pressure improved with minimal intervention. prior to discharge you were feeling well and blood pressures at baseline. of note, contrast will now be listed as an allergy on your medication/allergy list. please advise all future clinicians of this allergy as you should be pre-treated prior to receiving contrast in the future. . changes to your medications: decrease aspirin from 325mg daily to 81mg daily. . no other changes were made to your medications. . again it was a pleasure taking care of you. please feel free to contact with any questions or concerns. followup instructions: please follow-up with your outpatient cardiologist and pcp in next 1-2 weeks. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery esophageal reflux pure hypercholesterolemia unspecified essential hypertension percutaneous transluminal coronary angioplasty status dysthymic disorder other specified cardiac dysrhythmias old myocardial infarction family history of ischemic heart disease other drugs and medicinal substances causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to