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 is a 58 year-old caucasian male with a past medical history significant for coronary artery disease status post four vessel coronary artery bypass graft in who underwent evaluation of chest and upper arm discomfort times several weeks. in addition the patient was also experiencing exertional chest pain and dyspnea on exertion after one flight of stairs. on the patient underwent an ett thallium and exercise for seven minutes by protocol with chest pain, but no significant ekg changes on a normal thallium study. the patient was admitted to the cmi service on and underwent coronary catheterization that same day. during this catheterization lv gram revealed a sustained ejection fraction at 60% with evidence of a 70% proximal and 50% mid stenosis of the svt to pda graft and a 30% proximal stenosis of the svg to om2 graft as well as a 99% proximal stenosis of the svg to d1 graft. the patient underwent ptca and stent placement with no residual stenosis of the svg to d1 graft on the 8th with no complications at that time. notably the patient also was with a patent lima to lad graft during his first catheterization. on the the patient returned to the catheterization laboratory and underwent a percu-surge device procedure for the svg to pda lesion. notably this artery had diffuse disease proximally with 80% ulcerated stenosis and 40% mid stenosis. the patient underwent ptca and stent with observation of timi-2 fast flow. this procedure was complicated by evidence of distal embolization of the plaque during the procedure. hemodynamic monitoring at this catheterization revealed ra pressure of 7, pulmonary capillary wedge pressure of 7, cardiac index of 2.5 with a patent svg to d1 stent. the patient was kept on integrilin with a goal of 48 hours total therapy secondary to his complicated catheterization. several hours after his second cath on , the patient had an acute drop in his systolic blood pressures to the 70's. he responded with elevation of pressures after 500 cc iv fluid bolus. telemetry also showed three episodes of five beat nonsustained ventricular tachycardia. on the morning of the 10th the patient was complaining of pleuritic chest pain and mild shortness of breath. cks at this time were checked and were notably rising compared to the prior day. ekg at this time revealed st segment elevation of .5 to 1 mm in lead 3, avf and precordial lead v2 to v4 st depressions. later in the evening the patient continued to have constant chest pain associated only with shortness of breath. the pain improved in the semi-upright position, however, the patient had minimal relief with increasing of an iv nitroglycerin drip or morphine. after consultation of the interventional cardiology fellow it was believed that the patient was likely having a subacute myocardial infarction as indicated by ischemic changes on ekg and persistent chest discomfort post cath in the setting of a complicated catheterization with evidence of distal embolization. it was the impression of the staff interventional cardiologist that the patient was not suitable to take back to the catheterization laboratory, since there was no suitable therapy for small vessel distal embolization. the patient was transferred to the coronary care unit at this time for hemodynamic monitoring and for close observation. past medical history: 1. coronary artery disease status post four vessel coronary artery bypass graft in with a lima to lad graft, svg to om2, svg to d1 and svg to pda. 2. hypercholesterolemia. 3. hypertension. 4. history of tobacco use. allergies: the patient has no known drug allergies. medications on transfer: 1. aspirin 325 mg po q day. 2. plavix 75 mg po q.d. 3. zestril 5 mg po q.d. 4. hydrochlorothiazide 12.5 q day. 5. lipitor 10 mg po q.d. 6. meclozine 12.5 t.i.d. 7. integrilin at 15 cc per hour times 48 hours. 8. iv nitroglycerin drip. 9. percocet prn. 10. morphine sulfate prn. social history: the patient works in home room modeling and construction. occasional social alcohol use. he does not participate in any formal exercise program. he is married and has grown children. tobacco history as above. the patient is a former smoker. physical examination: vital signs on transfer, temperature 101.4. pulse 122. blood pressure 100/45. pulse 110. respirations 18. o2 saturation is 100% on 2 liters. 24 hour i and o are 11 35 and over 24 25 outs. general, the patient is a well appearing caucasian male in no acute distress. heent head is normocephalic, atraumatic. sclera and conjunctiva are anicteric. oropharynx is clear without erythema or exudate. neck is without evidence of jvd and supple without obvious lymphadenopathy. chest is clear to auscultation bilaterally. cardiovascular examination reveals a normal s1 s2, sinus tachycardia with a questionable pericardial rub and 2+ bilateral distal pulses. abdomen is soft and obese without tenderness, guarding or distention. there were normoactive bowel sounds in all four quadrants and no palpable hepatosplenomegaly. extremities are without clubbing, cyanosis or edema. neurological examination the patient is alert and oriented times four. cranial nerves ii through xii are grossly intact and motor and sensory examination is otherwise nonfocal. rectal examination the patient is guaiac negative. laboratories on transfer: white blood cell count is 11.3, hematocrit 30.2 down from 44.4 on admission. platelets are 196 with an mcv of 83. sodium 137, potassium 3.7, chloride 99, bicarb 27, bun 12 and creatinine .9, serum glucose is 143. cholesterol is ldl of 46, hdl of 35, triglycerides 129. ck on transfer are 197 with an mb fraction of 25, 86 with an mb fraction of 73 and 795 with an mb fraction of 70. ekg on transfer shows sinus tachycardia with a rate of 100, normal axis and intervals with 1 mm st segment elevations in 3 and avf, q wave in 3 and avf. diffuse t wave abnormalities inferolaterally. hospital cousre: the patient was observed in the coronary care unit. upon transfer on admission the patient was administrated .5 mg of morphine sulfate after which time he had complete resolution of his chest discomfort. the patient complained of no further shortness of breath. the patient's cks were checked serially and the patient was noted to be trending down on the day post transfer to the coronary care unit. at the time of transfer the patient was also noted to be intermittently hypotensive with a systolic blood pressure ranging 95 to 105, febrile and tachycardic. he was evaluated for possible bleeding source with a negative stool guaiac and the patient had no complaint of back pain for suspicion of retroperitoneal hematoma, nor did he have any presence of groin hematoma from coronary catheterization. serial hematocrits were checked and the patient was transfused one unit of packed red blood cells and stable post transfusion hematocrit. however, the patient's systolic pressures continued to remain low and the patient was still intermittently tachycardic. hence he was transfused yet another unit of packed red blood cells with resolution of his intermittent hypotension and maintenance of his systolic pressures into the 120's to 140's. the patient was also administered some lasix and complained of no further episodes of shortness of breath after brisk diuresis. the patient remained stable throughout the remainder of his coronary care unit stay. he was transferred to the cardiac medicine floor and underwent an transthoracic echocardiogram to evaluate his left ventricular function status post complicated catheterization. this study revealed preserved ejection fraction of 55 to 60% with mild mitral regurgitation, mild tricuspid regurgitation. no evidence of pericardial effusion. poor visualization of the right hearted windows. the patient was discharged home on for follow up with his primary care physician . and eventual follow up with his outpatient cardiologist dr. in . in discussion at the time of discharge with the patient's medication regimen, he stated that he had a problem with beta blockers in the past secondary to wheezing. this was discussed with the patient's inpatient attending dr. and it was felt that the patient would likely benefit from either a low dose beta blocker and an optimize pulmonary regimen including a steroid inhaler with albuterol for break through shortness of breath or wheezing as needed. the patient would follow up with any further pulmonary symptoms with dr. or with his cardiologist upon next evaluation. follow up appointments: the patient is to follow up with dr. on and with dr. if needed on at 2:30 p.m. discharge medications: 1. atenolol 12.5 mg po q day. 2. plavix 75 mg po q day times one month. 3. enteric coated aspirin 325 mg po q day. 4. lipitor 10 mg po q day. 5. flovent 44 micrograms meter dose inhaler two puffs inhaled b.i.d. 6. albuterol meter dose inhalers two to four puffs q 4 to 6 hours prn shortness of breath. 7. sublingual nitroglycerin .4 mg tab q 5 minutes times three prn chest pain. 8. lisinopril 5 mg po q day. 9. one po b.i.d. prn. allergy symptoms. 10. meclozine 25 mg po q 8 hourly prn. discharge diagnoses: 1. angina status post complicated catheterization. 2. non q wave myocardial infarction. 3. hypercholesterolemia. 4. anemia. , m.d. dictated by: medquist36 d: 14:22 t: 05:54 job#: procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters coronary arteriography using two catheters angiocardiography of left heart structures injection or infusion of platelet inhibitor left heart cardiac catheterization diagnoses: subendocardial infarction, initial episode of care unspecified essential hypertension acute posthemorrhagic anemia coronary atherosclerosis of autologous vein bypass graft cardiac complications, not elsewhere classified other and unspecified angina pectoris other complications due to other cardiac device, implant, and graft 

Answer: The patient is high likely exposed to