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: patient recorded as having no known allergies to drugs attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization history of present illness: yo male with known 3v cad and multiple prior stents who has previously refused cabg, sss s/p ppm, and myelodysplasia who transferred from - with chest pain. he has known 3 vessel cad with a tight lad lesion found in for which stent placement was not thought possible and he decline cabg. since then he has had stable angina responsive to sl ntg that he gets a few times per week. he typically gets chest pain with exertion or if hct drops which is frequent due to mds. this morning he had chest pain and pressure which was relieved with sl ntg but recurred approximately 30 minutes after. he ended up taking 4 sl ntg before presenting to -. he reports that the character of his chest pain is similar to his prior episodes of angina. he has a history of nstemis and angina in the setting of anemia. he missed his epogen dose last week, received a dose yesterday. per his son, his baseline hgb is 13.4 and had dropped to 11.4 upon presentation to . he denies any cough, pnd, orthopnea. he does endorse peripheral edema over the past 1 month for which he has been wearing compression stockings. at , his vitals were 66 149/70 18 97% on ra, 94% on ra. he became chest pain free with a nitro gtt and lasix. his troponin was 0.22 which is his baseline. his cxr showed pulmonary edema. he also recieved aspirin and plavix. though he had a chf exacerbation due to crackles on exam. he was sent here for admission to cardiology and optimization of his medications. in our ed, basic labs were sent and ecg looked unchanged from prior (v-paced with twi in v1-2). he continued on a nitro gtt. on transfer to the floor, vitals were 98.5 65 153/66 14 100. he also has new onset of hematuria today. he does not have a history of recent foley placement. he has a h/o microscopic hematuria in the past. on review of systems, s/he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. s/he denies recent fevers, chills or rigors. s/he denies exertional buttock or calf pain. all of the other review of systems were negative. cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: past medical history: macrocytic anemia- dropped hgb from 10.8->8.5 due to interrupted erthropoietin therapy myelodysplastic syndrome with macrocytic anemia and mild thrombocytopenia right and left upper lobe nodules soft tissue density on the lateral left side of the bladder, ? neoplasia parkinsonism hypertension psoriasis s/p appendectomy glaucoma spinal stenosis 1. cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: 1. cad, s/p stents x 3; s/p 2 palmaz stents to the mid and distal lcx in , s/p tristar stent to the mid pda and ptca to distal pda in ; ef was 61%. 2. sick sinus syndrome s/p ddd pacemaker -cabg: none -percutaneous coronary interventions: as above -pacing/icd: ddd pacemarker social history: patient lives with his wife of 67 years at home. his children are very involved in his care, son is a radiologist. he is retired from real estate business. -tobacco history: remote, smoked x 7 years in the 's -etoh: none (occasional use) -illicit drugs: none family history: father died of mi at age 87. brother and sister both died of malignancies in middle age. daughter currently has malignant glioma, undergoing treatment. no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: t 98.1 bp 154/78 hr 70 rr 20 96% ra general: awake, alert, in nad. oriented x3. mood, 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 10cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. iii/vi systolic murmur. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. with loud crackles bilaterally and soft rhonchi l>r. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no c/c/e. 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: admission labs: 04:15pm wbc-10.7 rbc-3.86*# hgb-13.7*# hct-42.5# mcv-110* mch-35.5* mchc-32.2 rdw-20.9* 04:15pm plt count-168 04:15pm pt-14.5* ptt-29.1 inr(pt)-1.3* 04:15pm glucose-129* urea n-34* creat-1.2 sodium-141 potassium-4.0 chloride-104 total co2-25 anion gap-16 04:15pm ck(cpk)-132 04:15pm ctropnt-0.21* other pertinent labs: 03:20pm blood thrombn-10.6 03:32pm blood inh scr-neg studies: ecg : atrial sensed ventricular paced rhythm rate, 77. there is no other diagnostic interim change. chest xray : new interval haziness/blunting at the left costophrenic angle, which could be due to left small pleural effusion and adjacent small atelectasis at the left lung base; however, cannot rule out pneumonia. tte : the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with hypokinesis of the mid inferolateral and anterolateral walls, and distal anterior, inferior and apical segments. the remaining segments contract normally (lvef = 45 %). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. impression: normal left ventricular cavity size with regional systolic dysfunction suggestive of multivessel cad. moderate pulmonary artery systolic hypertension. mild mitral regurgitation. chest xray : there is interval development of bilateral perihilar, right more than left, interstitial linear opacities continuing toward the lung bases, including the bilateral subpleural linear opacities as seen in particular in the right lower lobe, findings that are consistent with interval development of mild-to-moderate pulmonary edema. cardiomegaly is moderate and unchanged. there is no interval development of mediastinal widening. there is no appreciable increase in pleural effusion, although small amount of right pleural fluid is most likely present. renal ultrasound : 1. normal-sized kidneys without signs of hydronephrosis. small nonobstructive right renal stone is noted. 2. mucosal-based soft tissue nodule in the right posterolateral bladder wall suggestive of urothelial neoplasm. further evaluation with cystoscopy or mri would be indicated, when clinical conditions warrant. 3. enlarged prostate. cardiac cath report: pending at the time of discharge. patient had intervention 2 drug eluting stents placed to proximal lad using tandem heart intra-procedure. echo : conclusions left ventricular wall thicknesses are normal. there is severe regional left ventricular systolic dysfunction with akinesis of the inferolateral wall and severe hypokinesis of the mid to distal anterior wall and septum. right ventricular chamber size and free wall motion are normal. mild mitral regurgitation. compared with the prior study (images reviewed) of , overall ejection fraction has decreased with worsened function of the anterior wall, anterior septum and anterolateral wall. brief hospital course: #. angina: he presented with acceleration of his typical angina symptoms and had unstable angina on admission. he has known 3 vessel cad and he has declined cabg in the past. his medical regimen was optimized on admission and included plavix, full dose asa, imdur sr 60 mg by mouth twice daily, metoprolol, and a high dose statin. his cardiac enzymes fluctuated during this admission, and he continued to have anginal symptoms intermittently throughout the hospitalization. these episodes were typically responsive to sublingual nitro. after many discussions, the patient and family decided that his quality of life is unacceptably poor with his current angina. they decided to proceed with cardiac catheterization for stenting of his proximal lad lesion. he was taken to the cath lab and had a tandem heart used to place 2 des to his left main coronary artery and lad. he had a slight right groin hematoma after catheterization that remained stable. he was chest pain free after the procedure. #. pump: on admission, he had a history of 1 month of peripheral edema and he appeared volume overloaded by chest xray at . he had received iv lasix before transfer and appeared relatively euvolemic on admission. he had a tte after admission which showed preserved systolic function. he had one episode of hypoxia, shortness of breath, and increasing volume overload on physical exam that was responsive to iv lasix. he intermittently required low doses of lasix for pulmonary edema diagnosed by physical exam and chest xray. during cardiac catheterization, he had an echo that showed decreased lv systolic function compared to previous with an lvef of 20-25%. he should have a repeat echo in weeks now that he has been revascularized to assess for improvement in function. #. anemia/myelodysplasia: his hemoglobin remained in the 11.0-12.5 range during this admission. there was some concern for anemia-induced angina, and his hematocrit was maintained greater than 33. he was transfused a total of 4 units of blood during and prior to his cardiac catheterization and continued his outpatient procrit injections. his anemia was decreased on the day of discharge and he received an additional unit of prbcs with resulting post-transfusion hct of 31.9. he should likely have a hematocrit drawn in two days to assess for any continued drop. he had no change in his groin hematoma and no evidence of retroperitoneal bleed at the time of discharge. #. acute renal failure: his creatinine increased from 1.2 on admission to 2.9 at its peak. the nephrology service was consulted and his urine lytes were consistent with prerenal etiology. it was felt that his acute renal failure was due to poor forward flow in addition to light diuresis. renal ultrasound showed no hydronephrosis. he was given one small fluid bolus (500cc) to improve his creatinine and 2 units of blood for anemia. he had an additional 2 units during his catheterization. his creatinine slowly improved prior to his catheterization. his cardiac catheterization was delayed somewhat in order for his renal function to improve. he was given mucomyst and iv fluids prior to catheterization to prevent contrast nephropathy. his creatinine was 2.1 on discharge. his urine output should be followed as there is a risk of contrast induced nephropathy approximately 2 to 3 days after his catheterization. #. elevated ptt: he was started on subcutaneous heparin during this hospitalization for dvt prophylaxis and his ptt increased to approximately 70. the sq heparin was stopped, and his ptt remained elevated for approximately 5 days after stopping it. he had a mixing study that was negative for a factor inhibitor and his thrombin time was normal. the etiology of his elevated ptt was not entirely clear, but it was not worked up further for a specific factor deficiency. it continues to decrease at the time of discharge. #. hematuria: he had hematuria on admission and was found to have a mass in his bladder on renal ultrasound that was thought to be the cause of his hematuria. the patient and family did not want this worked up further. #. dysphagia: the patient experienced some dysphagia with his pills and liquids during his hospitalization. this was thought to be due to deconditioning and was not worked up further and he was given ensure plus for nutritional supplementation. he was able to tolerate po and pills for the remainder of his admission. #. code status: during this hospitalization, his code status was dni but he wanted a trial of chest compressions/shocks but did not want prolonged resuscitation. this was temporarily suspended during his cardiac catheterization. medications on admission: lisinopril 20mg po daily toprol xl 75mg po daily pravastatin 80mg po daily asa 325mg po daily sl nitro 0.4mg once daily prn plavix 75mg po daily isosorbide mononitrate sr 60mg twice daily vit b complex 1 tab po daily actonel 35mg po daily calcium 600 + d3 1 tab daily nascobal 500mcg/0.1ml nasal gel - 1 spray qweek timolol 2 drops twice daily cosopt 2%-0.5% eye drops - 1 drop at bedtime procrit 40,000 unit/ml injection colace 100mg zofran odt prn flomax 0.4mg po daily discharge medications: 1. toprol xl 25 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po once a day. 2. pravastatin 20 mg tablet sig: four (4) tablet po daily (daily). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain/pressure: can take every 5 minutes for 3 doses. 5. clopidogrel 75 mg tablet sig: two (2) tablet po daily (daily): please take this dose for 1 month. then take 1 tablet (75mg) daily. 6. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po bid (2 times a day). 7. b complex vitamins capsule sig: one (1) cap po daily (daily). 8. actonel 35 mg tablet sig: one (1) tablet po once a week: please take this medication at the dose and frequency you were prior to hospitalization. 9. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po daily (daily). 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 11. zofran odt 4 mg tablet, rapid dissolve sig: tablet, rapid dissolves po every 6-8 hours as needed for nausea. 12. eye drops ophthalmic 13. calcium 500 + d (d3) 500-125 mg-unit tablet sig: one (1) tablet po once a day. 14. procrit 40,000 unit/ml solution sig: one (1) inj injection once a week. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: coronary artery disease acute on chronic kidney disease secondary diagnosis: anemia myelodysplasia hematuria discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:out of bed with assistance to chair or wheelchair discharge instructions: you were admitted to the hospital due to chest pain. you also had acute renal failure while you were in the hospital that was thought to be due to poor forward blood flow from your heart. you were given both iv fluids and diuresis with iv lasix intermittently throughout your hospitalization. you also received 4 units of blood due to anemia. you underwent cardiac catheterization with dr. and had two drug-eluting stents placed in your coronary arteries. you had a hematoma (bruise) in your right groin after the procedure which did not get bigger. you also worked with physical therapy after this procedure.\ you were found to have a bladder mass on imaging during this hospitalization that is likely the cause of your hematuria (blood in your urine). at you and your family's request, we did not work this up further. please discuss this with your outpatient primary care physician, . . changes to your medications: -increased plavix to 150mg by mouth daily (you should take this dose for one month and then go down to 75 mg daily; please discuss this with your cardiologist at your next appointment). -stopped your lisinopril due to your low blood pressures and renal failure. this should be restarted once your kidney function returns to normal. please discuss this with dr. and dr. . please take all of your other medications as you were doing prior to hospitalization. followup instructions: you should follow-up with your primary care doctor, dr. . please call to make an appointment. in addition, you should follow-up with your cardiologist, dr. , in the next 2-3 weeks. please call his office to schedule an appointment. procedure: coronary arteriography using two catheters left heart cardiac catheterization insertion of drug-eluting coronary artery stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery intermediate coronary syndrome congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified hematoma complicating a procedure unspecified glaucoma chronic kidney disease, unspecified myelodysplastic syndrome, unspecified paralysis agitans cardiac pacemaker in situ hematuria, unspecified chronic diastolic heart failure 

Answer: The patient is high likely exposed to