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 attending: chief complaint: left ankle pain major surgical or invasive procedure: left ankle fusion history of present illness: 62 year old male with h/o cad, htn, hc, ?af (on coumadin - per pt b/o stents), ra, multiple prior myocardial infarctions s/p multiple stents, and recent in- thrombosis of om2 in in the setting of discontinuation of his clopidogrel for 5 days in anticipation of the same elective surgery, now again admitted for elective left ankle fusion for rheumatoid associated arthritis, found to have an nstemi post- transferred to medicine for further management. . since the ptca to his om2 in- thrombosis, the patient says he is back to his usual baseline. he does get reproducible angina with exertion (working in the yard), but very infrequently gets angina at rest (this is also longstanding). what limits his activity currently is his severe left ankle pain. before his ankle began really bothering him, about a year ago, he was walking three miles on the treadmill everyday with occasional nitroglycerin use, and no shortness of breath. now he simply can't exercise secondary to the pain. . he used to smoke remotely, three ppd but quit in the 70s. he doesn't recall having any pulmonary problems, and denies any dsypnea. . he underwent left ankle fusion on . his coumadin has been held since sunday (). he was continued on asa and plavix for the procedure, per cardiology and orthopedics, as his prior in- thrombosis occurred while off plavix. post-operatively, he developed new st depressions in i and avl as well as a bump in his cardiac enzymes. he was started on a heparin drip and transferred to medicine. . of note, post-op course was also complicated by nose bleed, now s/p nose packing. his hct dropped from admission hct of 35 to 25 post-op. ebl during operation was 400cc. . on arrival to the medicine floor, his vs were stable. he denied any cp throughout the hospital stay, only minimal chest pressure lasting a few seconds shortly prior to admission. also no sob or palpitations. he denies any dizziness and did not note any blood from below. he did remember blood coming from his oropharynx and nose post-operatively. . past medical history: 1) hypertension 2) hypercholesterolemia 3) coronary artery disease, status post multiple mis with stents, last ptca as above secondary to in- thrombosis of om2 while holding plavix. otherwise has had stents to proximal and mid lad, d1, lcx, om2, and multiple atherectomies/ptcas. on coumadin, clopidogrel, and asa given apparent hypercoagulability. 4) congestive heart failure, ef 30% 5) rheumatoid arthritis 6) glucose intolerance 7) ?af, on coumadin (per patient on coumadin b/o stents; per one recent cardiology omr note on coumadin for af) . detailed cardiac history: : acute mi treated with tpa. cath: 80% plad treated with dca, 30% dlad, origin d2 with 40% lesion, bifurcating om1 t.o. cath (+ett): 90% lesion in mlad at prior dca site, s/p x 2 placed to proximal and mid lad. 80% d2. cath d/t rest angina: s/p placement in om2 with unsuccessful ptca of lower pole. cath d/t exertional angina: previously stented om2 patent but with occcluded inferior pole, filling via collaterals. unable to cross with wire. 40% plad, 70-80% d2. s/p successful ptca and stenting of the proximal om2 using a 2.5 x 23 mm bx velocity . also s/p successful direct stenting of the proximal circumflex using a 3.5 x 8 mm bx velocity hepacoat . s/p ptca of d1. admitted to with rest angina.+nqwmi. s/p ptca/rotational atherectomy of the diagonal and ptca/rotational atherectomy and beta-brachytherapy of the om2 instent restenosis s/p 2.5x 15mm biodivysio to the lad r/i for a nstemi s/p two 2.5 x 23mm cypher stents to the lad acute chest pain, mlad thrombosis, s/p 2.5 x 13 and 2.5 x 8mm hepacoat stents to the lad. s/p 2.5 x 8mm cypher to om2 s/p 2.5 x 28mm cypher des to om1 st elevation mi om totally occluded at site, s/p ptca. patent lad stents. cath d/t rest angina, cath did not reveal any flow limiting cad. cath due to acute thrombosis of om2 stents after an ankle procedure, treated with thrombectomy and ptca. social history: he drinks alcohol, mostly on the weekends, and will have "a few" beers and "a few" margaritas on those times. he used to drink heavily but stopped in the 80s. he would drink a case of beer daily and have multiple hard liquor shots. he stopped this at his wife's encouragement. he currently lives at home with his wife. used to smoke 3 ppd, but quit in the 70s. no drug use. family history: mother with cva and mis starting at the age of 60. no premature cad. physical exam: prior to transfer to medicine (pre-op): 97.0, 102/60, 67, 18, 97% on ra. general: overweight caucasian male resting comfortably in bed. heent: moist mucous membranes. neck: no jvd. cor: rr, normal rate, distant heart sounds without obvious murmur. lungs: clear bilaterally. abdomen: normoactive bowel sounds, soft, non-tender, no bruits. extr: no edema. marked ulnar deviation of hands bilaterally with swan neck deformities. left ankle slightly warm compared to right, with hypertrophy of joint and limited mobility. neuro: strength is in the hip and knee flexion/extension, and upper extremity strength is at the elbows and wrists. . on transfer to medicine (post-op): 97.7, 108/62, 86, 18, 100% on 3l. general: overweight caucasian male resting comfortably in bed. somewhat sedated from narcotics post-operatively. heent: moist mucous membranes. clear op, no lesions, no blood visualized. no blood in nasal cavities visualized. neck: no jvd. thick neck. cor: rr, normal rate, distant heart sounds without obvious murmur. lungs: mild crackles at both bases. no rhales or rhonchi or wheezes. abdomen: normoactive bowel sounds, soft, non-tender. extr: no edema. marked ulnar deviation of hands bilaterally with swan neck deformities. left ankle and calf in cast. pertinent results: 08:30pm wbc-8.5 rbc-3.44* hgb-11.8* hct-35.5* mcv-103* mch-34.2* mchc-33.1 rdw-17.0* plt count-233 08:30pm glucose-143* urea n-29* creat-1.5* sodium-140 potassium-4.1 chloride-106 total co2-23 anion gap-15 . echo : ef 30%, posterolateral hypokinesis . last catheterization : 1. selective coronary angiography of this left dominant system revealed two vessel disease. there was mild disease in the lmca. the lad revealed widely patent stents. the lcx had a 30% isr of the proximal om2 and total occlusion of the om2 stents distally. the rca was totally occluded proximally. 2. limited resting hemodynamics revealed an opening aortic pressure of 111/63mmhg. 3. left ventriculography was deferred. 4. the thrombosis of the om2 was treated with thrombectomy and balloon angioplasty using a 2.0 mm, 2.5 mm and a 3.0 mm balloons. the final angiogram showed partially reestablished flow with no residual stenosis, no dissection and no embolisation. (see ptca comments) 5. ivus intorrogation of the om2/lcx/lmca did not show any significant lesions. it revealed a mld of 2.1 x 2.3 mm. (see ptca comments) final diagnosis: 1. late thrombosis of om2 stents. 2. successful ptca of the om2. 3. ivus examination of the om2/lcx/lmca showing no critical lesions. . pa cxr : the heart size is top normal in size. the aorta is tortuous but stable in contour. the lungs are clear. pleural thickening along the right mid costal surface unchanged compared to the previous study. no pleural effusion or pneumothorax is identified. . ankle xr (2 views) : a cast is in place, obscuring fine detail. allowing for this, there is an intramedullary rod extending across the tibiotalar joint and subtalar joint, secured by two screws in the tibial diaphysis, additional screw at the tibial metaphysis. an additional lower screw which is hard to fully evaluate on this view, and a distalmost screw extending through the calcaneus from posterior to anterior. question slight bowing of the calcaneal spur, which may be accentuated by beam obliquity. there is an osteotomy through the distal fibula and the distal fibular fragment is secured to the distal tibia by screw. multiple skin staples are present. the tibiotalar and subtalar joints appear to have been effaced. if clinically indicated, views centered in the hindfoot could help to better assess the joint spaces. . baseline ekg pre-op from : lad, twi i, avl, ?less than 1mm st elevations in avr and v1, poor rwp, lvh post-op ekg : same findings as above, in addition very small st depressions in i, avl (versus nonspecific) . ct abdomen/pelvis : no evidence of retroperitoneal bleed or other acute intraabdominal pathology. . cardiac cath : 1. selective coronary angiography in this left dominant circulation demonstrated three vessel coronary artery disease. the lmca had an origin 20% stenosis with 30% stenosis distally. the lad had a proximal 60% stenosis and mid 40% instent restenosis. the distal lad had only mild plaquing. the d1 was subtotally occluded. the lcx was without flow limiting disease proximally, but distally had an eccentric 40-60% stenosis after om2. om1 was a small caliber vessel with moderate diffuse disease. the om2 was totally occluded in the proximal . there was some collateral filling of the lower pole of om2. there was a 50% stenosis in l-pl. the rca was no engaged since it was known to be non-dominant and severely diffusely diseased. 2. limited resting hemodynamics from left heart catheterization demonstrated normal systemic arterial pressure, but severely elevated left heart filling pressure (27mmhg). there was no transaortic pressure gradient upon catheter pullback from the left ventricle to the ascending aorta. 3. left ventriculography was deferred due to renal insufficiency. final diagnosis: 1. three vessel coronary artery disease. 2. patent lad stents. 3. totally occluded om2 stents. 4. severely elevated left heart filling pressure. . cxr : moderate cardiomegaly has progressed, and there is slight increase in pulmonary vascular engorgement but no edema. heterogeneous opacification at the right lung base is new and could represent either atelectasis or aspiration or focal region of pneumonia or pulmonary hemorrhage. . echo : the left ventricular cavity size is normal. there is moderate regional left ventricular systolic dysfunction with inferolateral akinesis/hypokinesis and mid to distal anteroseptal and apical akinesis. estimated left ventricular ejection fraction ?30% (views suboptimal). the right ventricular cavity is dilated. right ventricular systolic function is borderline normal. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. an eccentric jet of moderate (2+) 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 trivial pericardial effusion. compared with the prior study (images reviewed) of left ventricular systolic function is probably similar but views are technically suboptimal for comparison. mitral regurgitation and tricuspid regirgitation are now more prominent. estimated pulmonary artery systolic pressure is now higher. . ct abd/pelvis : ct of the abdomen with intravenous contrast: lung bases demonstrate bilateral small pleural effusions and adjacent atelectasis. the liver shows no focal lesion. the gallbladder, spleen, pancreas, adrenal glands, kidneys are unremarkable. the intra-abdominal loops of large and small bowel are normal in caliber. abdominal aorta maintains a normal contour. mild atherosclerotic calcification is seen throughout the aorta and branched vessels. the celiac, sma, are normally opacified. incidental note is made of aberrant origin of the common hepatic artery from the aorta. no intra-abdominal free air, free fluid, or lymphadenopathy is appreciated. ct of the pelvis with intravenous contrast: the rectum, sigmoid colon, bladder, prostate, seminal vesicles are unremarkable. bilateral rectal sheath hematomas are present, the right measuring 6.2 x 5.6 cm and the left measuring 5.6 x 5.2 cm. hematocrit levels are seen within the rectal sheath hematomas, suggestive of anticoagulation or hypocoagulable state. note is made of a reservoir for penile prosthesis within the right lower pelvis. bone windows: no suspicious lytic or sclerotic lesion is identified. degenerative changes are seen within the lower lumbar spine, notably disc space narrowing and endplate sclerosis at l4-l5 and l5-s1. brief hospital course: 62 year old male with rheumatoid arthritis, cad, htn, hc, af, multiple prior myocardial infarctions s/p multiple stents and extensive history of cad and multiple mis, with last ptca in of om2 in thrombosis secondary to holding plavix and coumadin, admitted for ankle fixation, developed nstemi post-op, was transferred to medicine. hospital course c/b hypotension requiring ccu stay from to , with transient pressor support. found to have been septic, likely from lll hap, was on vanc/zosyn/azithro, then transitioned to po levo given gnr in sputum. later hospital course also c/b bilateral rectal sheath hematomas. . 1) hypotension/fever: patient developed ivf resistant hypotension to sbp in 70s on requiring transfer to ccu where he spiked. he was started on stress dose steroids. cxr showed a left lower lobe consolidation. sputum grew gnrs. a triple lumen cath was placed and he was given ivf resuscitation. he was started on zosyn and vanco for broad coverage of hosp acquired pna. vancomycin and zosyn were given from to . azithromycin was briefly administered as well (). patient was transitioned to po levofloxacn on given gnr in sputum and clinically stable. patient was continued on steroid taper after stress dose steroids. on transfer to medicine floor, patient was on prednisone 40mg qd which was tapered to his maintenance dose of 10mg daily. patient should continue levofloxacin for a total of 7 days. i&s was pending on gnr in sputum culture and should be followed up after discharge. patient was febrile and hemodynamically stable on discharge. he should follow up with his pcp after discharge. . 2) cad: multiple cardiac rfs including htn, hc, ra. h/o multiple mis, with last ptca in of om2 late in thrombosis and rca occlusion secondary to holding plavix and coumadin. ivus of om2/lcx/lmca without critical lesions. now with another nstemi post-op despite having continued asa, plavix. ekg showed new very small st depressions in i, avl (versus nonspecific finding). normal cardiac enzymes pre-op on . ck 124, but ck-mb of 16 with an index of 12.9 and troponin of 0.11 post-op on . ck went up further, likely because of muscle trauma during surgery (peaked at ). highest mb index remained at 12.9. cardiac cath was performed on which showed three vessel coronary artery disease, patent lad stents, but totally occluded om2 stents. also severely elevated left heart filling pressure were noted. no pci was performed on the om2 occlusion because there were collaterals from lpl and pci may shower emboli. pt remained without cp post-mi until when he developed chest burning which he stated was more like his "heartburn" pain. he took sl nitro with improvement of sx. an ekg was unchanged but his troponin was up to 2.0. no change in mgm given already maximal medical therapy. after transfer to the ccu he also had intermittent chest pain with slight st depressions v2-v6 which were rate-related. he responded to sl nitro. ces were flat and it was not thought to be acs. patient was continued on heparin drip until he developed rectal sheath hematomas (see below). patient was continued on asa, plavix as well as his bb, statin, imdur. his acei was held throughout most of his hospital course b/o arf (see below). acei was restarted at 5mg daily on day of discharge when his cr was around his baseline. patient should follow up with his cardiologist after discharge. . 3) rhythm: per recent cardiology omr note, on coumadin for af. per patient, on coumadin b/o stents. nsr on ekg. monitored on tele. coumadin was held peri-operatively. patient was continued on bb, titrated as bp tolerated. patient was also on heparin drip after nstemi (see above) which was discontinued towards the end of his hospital stay /o bilateral rectal sheath hematomas (see below). coumadin was held as well but restarted upon discharge at 5mg daily. inr should be checked two days after discharge, then twice weekly for one month, followed by monthly inr checks and adjustments of his coumadin dose. . 4) pump: ef 30% and posterolateral hypokinesis on last echo from 1/. euvolemic on exam. cxr without pulmonary edema. however, severely elevated left heart filling pressure were noted on cath. no lv-gram shot given cri. echo showed similar lvef (approx. 30%) but more prominent mr as well as pah. patient was diuresed as needed during hospital stay. he was continued on bb, asa, plavix as above. acei was held as above but restarted on day of discharge at 5mg daily. . 5) abdominal pain: patient developed increasing abdominal pain at the end of his ccu stay. patient was diffusely tender to palpation on re-transfer to medicine from ccu. had formed bm prior transfer. c. diff has been negative x1. lfts were normal only slightly elevated amylase/lipase. ct abd/pelvis showed b/l rectal sheath hematomas (5x5cm and 5x6cm). heparin drip and coumadin were discontinued. hct trended slowly down to 26 but remained stable thereafter. patient also received blood transfusion given insufficient level for cardiac issues (see below). zofran was given prn nausea. pain was resolving upon discharge and patient denied any n/v. . 6) hct drop: hct dropped from admission hct of 35 to 25 post-op. ebl during operation was 400cc. post-op course c/b nose bleed, requiring packing. on heparin gtt for nstemi. off coumadin peri-operatively. inr of 1.4 on transfer to medicine. guaiac negative on transfer. possible retropharyngeal bleed vs occult gi bleed given pt is on heparin gtt, steroids, plavix. ct abd/pelvis did not show any rp bleed. received total of 4u prbc with 20 iv lasix in between. ppi was increased to . hct up to 30 prior to cath, remained stable thereafter. hct has still been stable around 30-32 x24h prior to transfer to ccu but hct trended down to 25 in ccu. received blood transfusions to keep hct above 30 given intermittent cp in ccu. has been cp free for two days prior to re-transfer to medicine. hct was 28.7 on re-transfer but trended down again to 26. received another transfusion to keep hct around 28-30. hct remained stable towards discharge. hct was 36.3 on day of discharge. . 7) ra: advanced disease, s/p ankle fusion. admitted for fusion of left ankle. on chronic methotrexate, prednisone, and hydroxychloroquine. per his rheumatologist, methotrexate to be held for 3 weeks given the risk of infection. received hydrocort peri-op given long-term steroids use. also stress dose steroids in ccu for hypotension, then transitioned to po predisone again. dose was 40mg daily upon re-transfer to medicine which was further tapered. patient was continued on hydroxychloroquine. prednisone was tapered to maintenance dose of 10mg daily on day of discharge (was on 5mg prior to admission). . 8) s/p l ankle fusion: ankle destruction secondary to ra. now s/p fusion. completed post-op ancef x3 doses and post-op hydrocort x3 doses. tissue cultures from surgical samples with no growth. bivalve cast has been placed by ortho. patient should follow up with dr. in 2 wks post-op. patient was continued on pain meds (tylenol, gabapentin). post-op, patient was on dilaudid pca and iv as needed. weaned dilaudid pca and transitioned to oxycodone prn. staples should be taken out on per orthopedic recommendations. patient has an outpatient with orthopedics on that day for follow up. . 9) htn: was well controlled per last omr note from his cardiologist. continued bb, imdur. held acei for arf as below. held all bp meds during hypotensive episode (see above). continue bb, imdur and restarted acei upon discharge (see above). . 10) acute on cri: cr baseline at 1.2-1.4. post-op cr up to 1.9, thought to be prerenal given cr came down to 1.5 with ivf and blood transfusions. urine lytes checked after rehydration were not consistent with prerenal state (fena 1.6%, feurea 71%) but were likely checked too late. received pre-cath hydration with hco3 and mucomyst. cr came down to 1.1 post cath but jumped to 2.7 the next day when he was transferred to the ccu for hypotension. likely multifactorial (prerenal, hypotension, contrast-induced). cr peaked at 3.3 and trended down again with fluid resuscitation. it has been mostly around 1.3-1.8 in the ccu. cr was 1.6 on re-transfer to medicine and remained stable around this baseline thereafter. acei was held throughout most of his hospital stay but restarted upon discharge (see above). cr was 1.7 on day of discharge. . 11) chronic anemia: hct baseline at 31-35. hct drop post-op (see above) and after rectal sheath hematomas (see above). transfusions given as mentioned above. continued iron supplementation with bowel regimen. . 12) h/o glucose intolerance: monitored fs qid. riss. . 13) hyperlipidemia: continued statin . 14) fen: cardiac diet, npo for procedures . 15) ppx: heparin gtt and coumadin (discontinued after hematomas), plavix, bowel regimen, ppi . 16) access: piv, in ccu also cvl (right sc) . 17) code: full medications on admission: aspirin 325 mg daily clopidogrel 150 mg daily multivitamin pantoprazole 40 mg daily pravastatin 80 mg daily toprol xl 50 mg daily hydroxychloroquine 200 mg isosorbide 45 mg daily lisinopril 5 mg daily prednisone 5 mg iron 325 mg daily coumadin on hold methotrexate on hold . medications on transfer: - hydroxychloroquine sulfate 200 mg po bid - isosorbide mononitrate (extended release) 60 mg po daily - loperamide 2 mg po qid:prn diarrhea - acetaminophen 325-650 mg po q4-6h:prn pain/fever - metoprolol xl (toprol xl) 50 mg po daily - aspirin 325 mg po daily - nitroglycerin sl 0.3 mg sl prn - clopidogrel bisulfate 150 mg po daily - pantoprazole 40 mg iv q24h - cyanocobalamin mcg po daily - pravastatin 80 mg po daily - erythromycin 0.5% ophth oint 0.5 in od tid duration: 2 days - prednisone 5 mg po bid - ferrous sulfate 325 mg po daily - pyridoxine hcl 25 mg po daily - folic acid 2.5 mg po daily - gabapentin 300 mg po daily - hydromorphone (dilaudid) 2-4 mg po q4-6h:prn - hydromorphone (dilaudid) 0.12 mg ivpca lockout interval: 6 minutes basal rate: 0 mg(s)/hour 1-hr max limit: 1.2 mg(s) - zolpidem tartrate 5-10 mg po hs sleep - heparin iv per weight-based dosing guidelines discharge medications: 1. lorazepam 0.5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for anxiety. 2. oxycodone 5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain. :*20 tablet(s)* refills:*0* 3. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain: take up to 3 tabs, with 5 minute intervals. call your pcp. :*30 tablet, sublingual(s)* refills:*2* 4. clopidogrel 75 mg tablet sig: two (2) tablet po daily (daily). :*60 tablet(s)* refills:*2* 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. hydroxychloroquine 200 mg tablet sig: one (1) tablet po bid (2 times a day). :*30 tablet(s)* refills:*2* 7. pravastatin 20 mg tablet sig: four (4) tablet po daily (daily). :*30 tablet(s)* refills:*2* 8. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 9. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for pain/fever. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). :*30 tablet, delayed release (e.c.)(s)* refills:*2* 11. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 12. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 13. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 days: day 1 = . :*5 tablet(s)* refills:*0* 14. coumadin 5 mg tablet sig: one (1) tablet po once a day: 1 tab (5 mg) , tab (2.5 mg ) & tab , 5 mg then per dr. . :*30 tablet(s)* refills:*2* 15. toprol xl 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. :*30 tablet sustained release 24 hr(s)* refills:*2* 16. imdur 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. :*30 tablet sustained release 24 hr(s)* refills:*2* 17. foltx 2.5-25-2 mg tablet sig: one (1) tablet po once a day. 18. outpatient lab work check inr dx 427 please fax results to dr. discharge disposition: home with service facility: all care vna of greater discharge diagnosis: primary diagnosis: 1. left ankle fusion 2. nstemi post-op, s/p cath 3. cad with multiple mis, s/p multiple stents 4. systolic chf, ef 30% 5. hospital acquired pneumonia, requiring ccu stay 6. hypotension secondary to pneumonia, requiring ccu stay 7. bilateral rectal sheaths bleeds 8. acute on chronic renal failure 9. post-op blood loss anemia requiring several blood transfusions . secondary diagnosis: 1. rheumatoid arthritis 2. hypertension 3. hyperlipidemia 4. atrial fibrillation, on coumadin discharge condition: afebrile. hemodynamically stable. tolerating po. labs: hct 36.3 discharge instructions: you were admitted for ankle surgery. you developed a heart attack after the procedure as well as a pneumonia and bleed into your belly muscles. you have been worked up and treated for all of these issues. please call your primary doctor or return to the ed with fever, chills, chest pain, shortness of breath, nausea/vomiting, spontaneous bleeding or any other concerning symptoms. . please take all your medications as directed. you should take levofloxacin for five more days. you were also restarted on coumadin. inrs have to be checked frequently after discharge. discuss the need for methotrexate with rheumatologist . please keep you follow up appointments as below. followup instructions: check inr , dr. to manage coumadin. you have an appointment with cardiologist, dr. @ 11 am. please follow up with your primary care doctor (, ) in weeks from now. please also follow up with orthopedics as scheduled: provider: xray (scc 2) phone: date/time: 9:00 provider: , md phone: date/time: 9:20 your staples will be taken out at that time. procedure: coronary arteriography using two catheters left heart cardiac catheterization transfusion of packed cells control of epistaxis by anterior nasal packing ankle fusion subtalar fusion other fusion of foot diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pneumonia due to other gram-negative bacteria congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiac complications, not elsewhere classified atrial fibrillation personal history of tobacco use percutaneous transluminal coronary angioplasty status sepsis systolic heart failure, unspecified other and unspecified hyperlipidemia hemorrhage complicating a procedure hypotension, unspecified other specified septicemias old myocardial infarction unspecified disorder of kidney and ureter other complications due to other cardiac device, implant, and graft rheumatoid arthritis epistaxis hemoperitoneum (nontraumatic) 

Answer: The patient is high likely exposed to