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: penicillins / lovastatin attending: chief complaint: stemi, motorcycle accident major surgical or invasive procedure: cardiac catheterization iabp placement mechanical ventilation central venous line placement history of present illness: 52yo male presented to hospital s/p motorcycle vs car collision. the pt was traveling at a high rate of speed, swerved and fell. + loc. he and his motorcycle were found in the middle of the road. he was wearing a helmet. at , he was alert and oriented x 2. multiple facial lacerations were noted and a tetanus shot was given. vitals upon presentation to were bp 174/101, hr 80, rr 20, 100% on ra. pelvis, chest, and c-spine were unremarkable. he was transfered to for further care. prior to transfer an ecg had been obtained which showed inferior st elevations. he was taken to the cath lab. he was intubated using laryngoscopy due to airway swelling. cath showed thrombotic mid-distal rca lesion which was stented with bms x 2. he was then transfered to the ccu. u tox came back + for cocaine. plastic surgery evaluated and sutured facial lacs. trauma surgery is folllowing the patient along with ccu team. . unable to obtain ros mental status. . cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . in the ed here, initial vitals were 179/100, hr 84, rr 19, 100% o2 sat. past medical history: 1. cardiac risk factors: dyslipidemia 2. cardiac history: family denies -cabg: -percutaneous coronary interventions: -pacing/icd: 3. other past medical history: gerd, multiple orthopedic procedures (back, shoulder, knee) social history: tobacco history: former smoker, quit 2 months ago family denies etoh and ilicit drug use, say he's been clean for 22 years. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death per pt's daughter physical exam: vs: t=99.3 bp=103/65 hr=102 rr= 16 o2 sat= 100% general: sedated, intubated heent: periorbital ecchymosis and swetting. lips edematous. right forehead facial lact covered with dry gauze thyroid: no goitre, no signs hyperthyroidism cardiac: rr, normal s1, s2. soft systolic murmur. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no tenderness. + bs extremities: no edema skin: no stasis dermatitis, ulcers, scars, or xanthomas. gait: unable to assess muscle: tone appears normal pertinent results: admission labs: 11:00am blood wbc-15.9* rbc-5.24 hgb-15.2 hct-43.0 mcv-82 mch-28.9 mchc-35.3* rdw-14.1 plt ct-214 11:00am blood pt-11.8 ptt-20.0* inr(pt)-0.9 11:00am blood fibrino-288.4 03:00pm blood glucose-190* urean-16 creat-0.8 na-135 k-4.5 cl-103 hco3-24 angap-13 11:00am blood ck(cpk)-667* 11:00am blood lipase-20 11:00am blood ctropnt-<0.01 03:00pm blood calcium-8.2* phos-2.8 mg-1.9 11:00am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 11:17am blood glucose-170* lactate-1.6 na-141 k-5.1 cl-103 calhco3-23 11:17am blood freeca-1.03* cardiac enzymes: 11:00am blood ck(cpk)-667* 04:48pm blood ck(cpk)-1662* 10:43pm blood ck(cpk)-1887* 04:10am blood ck(cpk)-2627* 10:00am blood ck(cpk)-4153* 03:59am blood ck(cpk)-4480* 02:47pm blood ck(cpk)-3689* 11:00am blood ctropnt-<0.01 04:48pm blood ck-mb-137* mb indx-8.2* 10:43pm blood ck-mb-163* mb indx-8.6* ctropnt-1.50* 04:10am blood ck-mb-259* mb indx-9.9* 10:00am blood ck-mb-438* mb indx-10.5* 08:27pm blood ck-mb-422* ctropnt-6.60* other notable labs: : hba1c 6/0 : alt 35, ast 44, alkphos 55, tbili 0.7, albumin 2.9 : tsh 3.0, t4 5.1, free t4 0.88 discharge labs : wbc 6.7, hct 36.1, plt 428 na 141, k 4.7, cl 107, hco3 26, bun 15, cr 0.9, glucose 110 ca 8.4, mag 2.1, phos 4.3 pt 14.4, ptt 26.3, inr 1.2 admission ecg : sinus rhythm. compared to the previous tracing of there is st segment elevation in the inferolateral leads and st segment depression in the anteroseptal leads suggesting acute myocardial infarction of the inferolateral territory. repeat ecg : acute inferior myocardial infarction. probably mid-right coronary lesion with st segment depression in lead avl and avr being negative. st segment elevation in lead iii greater than in lead ii. a-v dissociation is not present. there is some irregularity to the rhythm suggesting capture beats. this may be interference dissociation with a junctional rhythm that is rapid. since the previous tracing of junctional rhythm is present with interference dissociation. admission cxr : low inspiratory lung volumes, but otherwise no acute cardiopulmonary process. cardiac cath : 1. selective coronary angiography in this right dominant system demonstrated one vessel disease. the lmca had no angiographically apparent disease. the lad had no angiographically apparent disease. the cx had no angiographically apparent disease. the rca had a proximal 50% stenosis as well as a distal 70% stenosis that was thrombotic and ulcerated. the distal rca stenosis was located proximal to the pl/pda bifurcation. 2. successful ptca and stenting of distal rca with a 4.5x28mm vision bms postdilated to 5.0mm. 3. successful pci of proximal pl with 5.0x18 ultra stent. 4. airway compromise from trauma requiring fiberoptic intubation by anesthesia staff. 5. unsuccessful ptca of distal pl cutoff with 2.5mm balloon. 6. successful rescue ptca of pda origin with 2.0x15mm apex balloon. final diagnosis: 1. one vessel coronary artery disease. 2. stemi 3. successful pci distal rca. 3. successful pci proximal pl. 4. unsuccessful ptca of distal pl cutoff. 5. successful rescue ptca of pda origin. 6. successful fiberoptic intubation by anesthesia staff for airway protection. ct head w/o contrast : no acute intracranial abnormality ct c-spine w/o contrast : no evidence of acute fracture or malalignment of the cervical spine. ct sinus/mandidble/maxillofacial non-contrast : multiple facial fractures are seen involving the bilateral nasal bones, bilateral maxillary sinuses (anterior, lateral, posterior and medial walls), the right palatine process of the maxilla and palatine bone, bilateral pterygoid plates, bilateral frontal processes of the maxillae, right lateral orbital wall and right orbital floor. the globes appear intact. no extraocular muscle herniation is seen. the bilateral lamina papyracea are intact. blood is seen throughout the bilateral maxillary sinuses, ethmoid air cells, sphenoid sinuses and frontal sinuses. soft tissue swelling and hematoma is seen in the frontal scalp along with subcutaneous emphysema extending to the right periorbital region and along the right cheek. subcutaneous emphysema extends to the masticator space bilaterally, right greater than left. the globes appear intact. no mandibular fracture is seen. impression: multiple bilateral facial fractures with involvement of the right lateral orbital wall and floor as described above. the globes appear intact and no evidence of ocular muscle entrapment is seen. ct abdomen and pelvis with contrast : 1. no acute traumatic injuries seen within the torso. 2. left adrenal nodule, which does not meet criteria for an adrenal adenoma on this exam. further evaluation with dedicated ct or mri of the adrenal glands is recommended. 3. mild dependent atelectasis in both lungs. tte : there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate regional left ventricular systolic dysfunction with inferior, inferolateral and inferoseptal akinesis. the remaining segments contract normally (lvef = 30%). right ventricular chamber size is normal with moderate global free wall hypokinesis. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. no aortic regurgitation is seen. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: moderate regional biventricular systolic dysfunction, c/w rca-territory infarction and rv infarction. mild mitral regurgitation. mild pulmonary hypertension. cardiac cath : 1. selective coronary angiography of this right dominant system revealed one vessel coronary artery disease. the rca was 100% occluded proximal to the prior stent. the lca was not engaged. 2. limited resting hemodyanmics revealed severe hypotension with a central pressure of 86/53 mmhg on high dose dopamine. 3. successful placement of 40cc iabp for hemodyanamic support. final diagnosis: 1. one vessel coronary artery disease with occluded rca due to stent thrombosis. 2. severe hypotension on high dose dopamine. 3. successful placement of iabp for hemodynamic support. ct head w/o contrast : 1. new small right parafalcine subdural hematoma. 2. new scalp collections, left greater than right, likely evolving hematomas. overlying fascial enhancement is likely inflammatory, but please correlate clinically to exclude the possibility of superimposed infection. ct sinus with contrast : 1. extensive facial fractures as described above, overall unchanged in appearance since . 2. interval increase in opacification of the paranasal sinuses, in part due to blood. this is a common finding in intubated patients. however, acute sinusitis cannot be excluded, if it is suspected on clinical grounds. ct chest/abdomen/pelvis with contrast : 1. no acute intra-abdominal pathology or source of infection identified. 2. interval development of small pericardial effusion and moderate bilateral pleural effusions with fissural component on the left. compressive atelectasis of left greater than right lower lobes. 3. fatty deposition in the liver. 4. interval development of trace amount of free fluid within the abdomen and pelvic cavities, as well as interval increase in subcutaneous edema likely reflect a slightly fluid overloaded status. tte : left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is severely depressed (lvef= 25 %) secondary to extensive inferior and posterior akinesis with focal dyskinesis of the midventricular segment of the inferior free wall. the right ventricular cavity is dilated with depressed free wall contractility. there is a small pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade. compared with the findings of the prior study (images reviewed) of , focal dyskinesis of the inferior free wall is now present. tte : no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is severe regional left ventricular systolic dysfunction with infer-septal, inferioa, and infero-lateral hypokinesis to akinesis. the apex appears hypokinetic. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is a small to moderate sized pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , no change. impression: no vsd or pseudoaneurysm seen. ct head w/o contrast : 1. no acute intracranial hemorrhage. previously seen tiny right parafalcine subdural hematoma has since resolved. 2. multiple facial fractures as before, incompletely assessed on this study. no new fracture is identified. 3. resolution of small bilateral scalp hematomas. ecg : supraventricular tachycardia with a ventricular premature beat. inferior st segment elevation with q waves and t wave inversions suggesting an myocardial infarction, could be recent/acute. t wave inversion in leads i, avl and v5-v6 also suggest ischemia. clinical correlation is suggested. low qrs voltage in the limb leads. brief hospital course: 52yo male admitted after motorcycle accident and found to have inferior stemi, who underwent emergent cardiac cath with bms to distal rca. #) stemi - patient brought to ccu s/p emergent cardiac cath for inferior stemi, which revealed a proximal 50% stenosis of the rca as well as a distal 70% stenosis that was thrombotic and ulcerated. patient had bms placed in distal rca. there was evidence of right ventricular ischemia/infarction. of note, patient had no previously known h/o cad, but his urine tox screen was positive for cocaine on presentation. the patient later denied any recent cocaine use. a tte obtained the next day revealed moderate regional biventricular systolic dysfunction, c/w rca-territory infarction and rv infarction, mild mitral regurgitation, and mild pulmonary hypertension. the patient developed ventricular bradycardia and hypotension, and swan that was placed showed elevated pressures in ra, rv, la/wp indicating biventricular failure. repeat cath the following day showed thrombosis of rca stent, and a decision was made to medically manage the patient as at this point microvascular perfusion was severely impaired by distal embolization and clot formation. post cath he was gravely ill with acute systolic chf and right ventricular failure. he had an iabp placed for support, which was gradually weaned and pulled. his cardiac enzymes peaked on : ck 4480, mb: 300, trop: 6.21. the patient was aggressively diuresed after developing significant pulmonary edema, and his fluid balance was closely monitored given his pre-load dependence in setting of rv infarct. he had several repeat ttes during the admission, and most recent echo was on . echo showed severe regional left ventricular systolic dysfunction with infer-septal, inferioa, and infero-lateral hypokinesis to akinesis, a hypokinetic apex, mildly dilated rv, mild global free wall hypokinesis, mod-severe mr, and a small to moderate pericardial effusion without evidence of tamponade. #) supraventricular tachycardia/atrial fibrillation - on night of initial presentation, s/p pci, rhythm went from sinus tachycardia to atrial tachycardia with ventricular bradycardia; bp 60-70/40s. arrhythmia thought to be secondary to av nodal infarct (rca branch) causing some degree of heartblock. per ep, patient appeared to have 2:1 conduction at higher hrs with good conduction at lower hrs (~50), and pacemaker was not indicated at the time. on patient had several episodes of sustained monomorphic v tach, lasting up to 2 min at a time with increasing frequency. per ep recs, patient started on amiodarone bolus and drip. he continued to have several runs of non-sustained v-tach, and was started on metoprolol tartrate for additional rate control. the amiodarone was later stopped, but the patient was continued on metoprolol. he began having several episodes of a fib/flutter on , without hemodynamic compromise, and his rhythm would spontaneously convert back to normal sinus rhythm. he had an episode of symptomatic bradycardia on , with ecg/telemetry showing retrograde p waves and junctional rhythm, rate 50/min. the patient was subjectively sob but not hypoxic, and episode was brief. no further episodes of symptomatic bradycardia, but patient should be closely monitored. of note, patient had episode of a fib/flutter on for which he received 2.5mg metoprolol iv, with resultant drop in bp and requiring 250cc bolus ns. his chads score is 1 and he will receive aspirin for thromboembolic prophylaxis. #) systolic heart failure: patient has left ventricular dysfunction likely seconary to his stemi with an ejection fraction of 30%. his heart failure regimen includes metoprolol, lisinopril, and spironolactone. he was initially managed with lasix but was autodiuresing well, so his lasix was held on . this will need to be restarted as an outpatient to prevent volume overload. #) hypotension - on night of presentation s/p cath, patient developed atrial tachycardia with ventricular bradycardia and bp 60-70/40s. he was started on dopamine for pressure support, and would require ongoing support with several pressors to keep map at goal of >65. he was eventually weaned off pressors, however his sbps generally remained in the 80s-90s. he had some degree of orthostatic hypotension, and his anti-hypertensive and diuretic regimen were adjusted accordingly. of note, patient's sbp persistently in 80s-90s in days prior to discharge. patient asymptomatic with sbp in 80s. #) respiratory status - patient sustained multiple facial fractures in the mva, and required intubation for significant airway swelling. during his ccu course, he was gradually weaned off ventilator support, and he was successfully extubated on . #) sinusitis/fever - during early hospital course, patient was persistently febrile and diaphoretic. in setting of multiple facial fractures, he was started on broad spectrum antibiotic coverage. per id, patient was on regimen of vancomycin, aztreonam, cipro, and metronidazole (given penicillin allergy). no clear source of infection was initially identified, although it was felt that patient may have develoepd sinusitis in setting of facial trauma. ct sinus revealed opacification of sinuses, however ent consult did not feel there was any pus, abscess or fluid collection ammenable to drainage. the patient's antibiotic regimen was tailored back to metronidazole and levofloxacin, for a 14-day course. he had a picc placed on . the patient was also placed on standing tylenol during the time of his persistent fevers. prior to discharge, the patient was off all antibiotics and remained afebrile. he had 1/4 bottles on blood culture positive for coag negative staph, which was felt to be a contaminant. repeat blood cultures were negative. #) facial fractures - multiple facial fractures noted on ct, including the bilateral nasal bones, bilateral maxillary sinuses (anterior, lateral, posterior and medial walls), the right palatine process of the maxilla and palatine bone, bilateral pterygoid plates, bilateral frontal processes of the maxillae, right lateral orbital wall and right orbital floor. blood was present in the bilateral maxillary sinuses, ethmoid air cells, sphenoid sinuses and frontal sinuses. the globes appeared intact with no evidence of ocular muscle entrapment. he was seen by trauma surgery, plastic surgery, and ophthomology. plastic surgery irrigated and sutured facial lacerations in ccu, and ophtho was consulted for periorbital swelling and orbital fx on ct. they did not feel there was evidence of entrapment or intraoccular involvement. #) asymmetric pupils - left pupil noted to be 1-2mm more constricted than the right, and neurology was consulted. both left and right pupil would constrict to light. immediate ct scan could not be obtained secondary to patient's hemodynamic instability, but ct head once patient medically stable revealed only a small subdural hematoma. ophthomology was , and felt it was highly unlikely any intraocular pathology was contributing to his asymmetric pupils. #) delirium/agitation - patient developed agitation and delirium later in his hospital course, thought to be icu-related delirium. he was seen by psychiatry, and started on a regimen of olanazpine and mirtazapine. he also responsed well to additional olanzapine prn agitation. he had some difficulty sleeping, and seemed to respond well to trazadone prn insomnia. patient will have neuropsych testing in outpatient setting. #) hyperglycemia - the patient had no previous diagnosis of diabetes, but was persistently hyperglycemic during ccu course, requiring glargine and an insulin sliding scale. hba1c was 6.0. he did not tolerate metformin, and was briefly started on glyburide. however he had some lower blood sugars in the 60s on glyburide, and this medication was stopped. he will need close monitoring of his blood sugar levels following discharge. #) fen - the patient was started on tube feeds via og tube while he was intubated. his diet was advanced following his extubation, and he was tolerating a cardiac healthy regular diet at time of discharge. medications on admission: glucosamine hcl 1500mg w/msm 1500ug b-50 - high energy complex prilosec 20mg daily omega 3 fish oil vitamin e 400 iu potassium gluconate 550mg mvi daily simvastatin 20mg daily discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. docusate sodium 50 mg/5 ml liquid sig: po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 6. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 7. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 8. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 9. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). 10. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 11. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 12. olanzapine 2.5 mg tablet sig: one (1) tablet po daily (daily). 13. olanzapine 2.5 mg tablet sig: two (2) tablet po hs (at bedtime). 14. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for dyspepsia. 15. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for dyspepsia. 16. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 17. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: two (2) drop ophthalmic qid (4 times a day) as needed for dry eyes. 18. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic hs (at bedtime) as needed for dry eyes. 19. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). discharge disposition: extended care facility: discharge diagnosis: acute st-elevation myocardial infarction acute systolic heart failure status post motorcycle accident facial fractures gastroesophageal reflux disease discharge condition: good. able to ambulate with walker. mental status alert and oriented to person, place, and time discharge instructions: you were admitted because you had a heart attack and motorcycle accident. you required cardiac catheterization, mechanical ventilation, and initiation of heart medications to reduce your risk of having future heart attacks. you were also found to have heart failure. please take all of your medications as prescribed. please attend all of your follow-up appointments. weigh yourself every morning, md if weight goes up more than 3 lbs. eat a heart-healthy and low sodium diet. this is important because of your heart failure. followup instructions: cardiology: , md e/sh-446c 10:40 am ( neuropsychology: provider: , phd date/time: 9:00 building (/ complex), phone: ophthalmology: plesae call to schedule an appointment at or follow-up with your local opthalmologist procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization left heart cardiac catheterization coronary arteriography using a single catheter insertion of endotracheal tube enteral infusion of concentrated nutritional substances implant of pulsation balloon suture of laceration of lip linear repair of laceration of eyelid or eyebrow transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] destruction of cranial and peripheral nerves procedure on three vessels diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux pure hypercholesterolemia mitral valve disorders congestive heart failure, unspecified atrial fibrillation other chronic pulmonary heart diseases atrial flutter hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) candidiasis of mouth cocaine abuse, unspecified paroxysmal ventricular tachycardia open wound of forehead, without mention of complication other and unspecified hyperlipidemia alkalosis cardiogenic shock acute myocardial infarction of other inferior wall, initial episode of care osteoarthrosis, unspecified whether generalized or localized, site unspecified other complications due to other cardiac device, implant, and graft other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist hypoxemia acute systolic heart failure hyperosmolality and/or hypernatremia closed fracture of malar and maxillary bones closed fracture of orbital floor (blow-out) delirium due to conditions classified elsewhere open wound of lip, without mention of complication closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration closed fracture of nasal bones acute sinusitis, unspecified anisocoria exposure keratoconjunctivitis 

Answer: The patient is high likely exposed to