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: shoulder pain/hypertensive emergency major surgical or invasive procedure: cardiac cathterization history of present illness: ms. is an 83 year old female with htn, iddm, cri, and no prior cardiac history who presents with left shoulder pain, sob, and chest tightness. pt had flipped a mattress the previous night, and experienced b/l shoulder achiness that evening. she also had chest tightness that she associated with an ongoing cold, and tightness was relieved with vapor rub. this am, she thought she felt cold symptoms coming on, took a dose of robitussin, and proceeded to have sob with vomiting of clear/white phlegm, non-radiating substernal chest tightness, and bilateral shoulder pain. pain/sob was not worsened or relieved with by any factors. patient had symptoms at rest. there is no history of pnd, orthopnea, presyncope, syncope, or palpitations. daughter was concerned, and called ems. on arrival, ems found bs to be 404. bp was found to be 264/98. pt was given asa 324mg and taken to the ed. . of note, pt reports missing only her lisinopril dose this am. one week ago, she self titrated down her humalog 75/25 to 42u qam, 20u qpm, as she had been having bs in the 60s-80s. she is followed at . she has noted having decreased exercise tolerance over the past week. she is normally very active with her adls at home. daughter is concerned that pt may be over-exerting herself. pt has been admitted for hypertensive ?urgency in after inadvertantly holding all her bp and insulin/anti-glycemic medications prior to cataract surgery. bp at time of admission then had been systolic 180s, and fs mid-300s. . in the ed, initial vitals were t:98.2 hr:74 bp:264/98 rr:24 o2sat:98%ra. ekg was found to have 1mm ste in avr and v1, 1-2mm std in ii, ii, v4-v6. pt was started on a labetalol gtt at 1mg/min and given zofran 4mg iv x 1. code stemi was activated, and pt was received 4l o2 nc, ng 0.4mg x 3, plavix 600mg po x 1, heparin bolus 3600u iv x 1, integrillin 11mg iv x 1, and morphine 2mg iv x 1, and ivf x 1l. pain had completely resolved from ->0/10 after labetalol gtt and morphine. troponin was elevated at 0.17. cxr prelim read showed mild heart failure, with moderate cardimegaly and small bilateral pleural effusions and bibasilar atelectasis. she was evaluated by the cardiology fellow in the ed, and ekg was interpreted as lvh with strain rather than acute stemi. she was admitted to the ccu for further evaluation and management. . in the ccu, pt's chest tightness had completely resolved. she was still having some mild sob at rest. pain in shoulders had also resolved. the patient denies any palpitations or syncope, claudication-type symptoms, melena, rectal bleeding, or transient neurologic deficits. no change in weight, bowel habit or urinary symptoms. no cough, fever, night sweats, arthralgias, myalgias, headache or rash. all other review of systems negative. past medical history: hypertension type ii dm w/ eye complications (macular edema, non proliferative diabetic retinopathy) paget's disease cataract extraction hypercholesterolemia cri, creatinine 1.3 (), stage iii osteoporosis rickets, as a child oa/ knees h/o carpal tunnel syndrome h/o lipodystrophy h/o dvt ~ , s/ le neuropathy s/p burn bilat fa, 's ? h/o heart murmur . cardiac risk factors: +diabetes, ?dyslipidemia, +hypertension . cardiac history: cabg n/a . percutaneous coronary intervention: n/a . pacemaker/icd: n/a . other past history: see above social history: denies smoking, alcohol, drug history. lives with 21 year old grandson, is independent with all . gets support from family and neighbors as needed. currently driving. there is no family history of premature coronary artery disease or sudden death. family history: non contributory physical exam: vs - 97.0 69 160/65 15 100%4l gen: wdwn middle aged female 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 to angle of mandible. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal soft s1, nml s2. no m/r/g. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. occasional bibasilar crackles; otherwise ctab with no other crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: cn2-12 intact grossly; sensation intact diffusely, strenght diffusely in ue/le muscles bilaterally pertinent results: admission labs wbc-7.9 rbc-3.74* hgb-10.8* hct-32.1* mcv-86 mch-28.9 mchc-33.7 rdw-14.9 plt ct-294 pt-17.2* ptt-150* inr(pt)-1.6* glucose-378* urean-24* creat-1.3* na-133 k-4.3 cl-96 hco3-25 angap-16 ck(cpk)-184* calcium-8.8 phos-4.2 mg-1.4* iron-37 cholest-216* triglyc-58 hdl-94 chol/hd-2.3 ldlcalc-110 triglyc-58 hdl-94 chol/hd-2.3 ldlcalc-110 caltibc-278 vitb12-577 folate-greater th ferritn-154* trf-214 06:55am blood calcium-8.8 phos-4.6* mg-2.0 biomarkers ctropnt-0.17* ck-mb-26* mb indx-5.1 ctropnt-1.52* ck-mb-20* mb indx-4.7 ctropnt-1.45* ck(cpk)-184* alt-29 ast-91* ck(cpk)-512* alkphos-135* totbili-0.4 blood ck(cpk)-428* other labs glucose-63* urean-44* creat-1.7* na-138 k-4.1 cl-103 hco3-28 angap-11 pt-13.8* ptt-29.1 inr(pt)-1.2* wbc-5.8 rbc-2.86* hgb-8.5* hct-24.6* mcv-86 mch-29.6 mchc-34.3 rdw-15.1 plt ct-277 u/a 11:57pm urine color-straw appear-clear sp -1.012 07:47pm urine color-yellow appear-clear sp -1.011 11:57pm urine blood-lge nitrite-neg protein-30 glucose-1000 ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 07:47pm urine blood-mod nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr 07:47pm urine rbc-30* wbc-9* bacteri-none yeast-none epi-1 07:47pm urine casthy-3* reports/imaging cxr: the heart size is mildly enlarged. the aorta is tortuous. the hilar contours are normal. small bilateral pleural effusion and bibasilar atelectasis are noted. mild pulmonary vascular congestion is visualized. severe degenerative changes of the thoracic spine are noted. a sclerotic lesion of the right humeral head most likely represents a bone island. impression: mild pulmonary vascular congestion and small bilateral pleural effusions. : echo the left atrial volume is increased. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with mild hypokinesis of the mid to distal inferolateral wall. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with mild hypokinesis of the mid to distal inferolateral wall. diastolic dysfunction. mild to moderate mitral regurgitation. moderate pulmonary artery systolic hypertension. renal duplex impression: 1. no hydronephrosis. 2. bilateral pleural effusions and a scant trace of ascites. 3. no evidence of renal artery stenosis. cardiac cath comments: 1. selective coronary angiography of this right dominant system revealed severe diffuse 3 vessel cad. the lmca had a distal 20% stenosis. the lad was heavily calcified and had a diffuse calcified proximal-mid stensosis comme% spanning the origin of d1. there was diffuse disease in the distal/apical lad to 70%. d1 had a proximal tubular 80% stenosis. the lcx was heavily calcified with a proximal 30% stenosis, diffuse 60% stenosis in the mid portion, and distal stenosis to 80% at the lpl. all oms were small and diffusely diseased. there were distal cx collaterals to the rpl. the ramus was moderately calcified with a mid tubular 85% stenosis. the rca was heavily calcified with a proximal 80%, mid diffuse 70% and distal 65% stenosis. the rpda had a 40% proximal and 80% distsal stenosis, with distal competitive flow from collaterals. there was diffuse disease in a small rpl1 and modest rpl2. 2. limited resting hemodyanamics revealed elevated left sided filling pressures with a lvedp of 20mm hg (respiratory variation ranged from 12 to 26mm hg). there was no transvalvular aortic gradient on careful pullback of the catheter from the lv to the aorta. there was severe systemic arterial hypertension despited tng at 200mcg/min iv. 3. abdominal aortography demonstarted a smooth aorta with singla patent renal arteries bilaterally. there was mild atherosclerosis of a tortuous left iliac artery. final diagnosis: 1. extensive 3 vessel coronary artery disease. 2. moderate left ventricular hypertensive diastolic heart failure. 3. severe systemic systolic arterial hypertension. 4. mild atherosclerosis of the left iliac artery. 5. no angiographic evidence of flow-limiting renal artery stenosis. brief hospital course: patient is an 83 y/o f with htn, dm2 on insulin, cki, no prior cad hx who presents with l shoulder pain and ekg changes in setting of hypertensive emergency. # hypertensive emergency: patient initially on nitro gtt then weaned off as bp improved on po medications. hypertensive emergency was thought to be multifactorial and secondary to med noncompliance. she did not have evidence of renal artery stenosis on cath or duplex. metoprolol was changed to labetalol with improved control. amlodipine was also added. she was continued on lisinopril. # chronic diastolic heart failure: satting high 90s on room air. started on lasix 40mg daily which she tolerated well with slight bump in creatinine on day of discharge. she should have repeat labs as outpatient. continued acei and bb . # cad: pt had nstemi in setting of hypertensive emergency. cath showing 3vd, with cardiac surgery not planning to intervene. continued asa, lisinopril, and changed metoprolol to labetalol. continued statin . # dm2: labile sugars, ranging 88 to 342 o/ following. she was continued on humalog 75/25, 30 units qam and 20 units qpm with hiss. she will have outpateint follow up with . . # stage iii crf: cr on admission 1.3 (baseline at or above this level), now 1.7 after gentle diuresis with lasix. also be elevated on from cath. she should have repeat labs as na outpatient for further monitoring while on lasix. # hyperlipidemia: added high dose simvastatin given cad. . # anemia: hct stable in high 20s. . # code: presumed full . medications on admission: lisinopril 40mg po daily (last dose 2/28) metoprolol 100mg po daily metformin 500mg po bid aspirin 81mg po qhs humalog 75-25 kiwkpen 100units/ml 54units sc qam (has been taking 42u) humalog 75-25 kiwkpen 100units/ml 22 units sc qpm (has been taking 20u). discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. nitroglycerin 0.3 mg tablet, sublingual sig: tablet, sublinguals sublingual prn (as needed) as needed for chest pain: take 5 minutes apart, call 911 if you still have chest pain after 3 doses. disp:*1 bottle* refills:*1* 3. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 4. amlodipine 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 5. simvastatin 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 6. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. insulin lispro protam & lispro 100 unit/ml (75-25) insulin pen sig: forty (40) units subcutaneous once a day. 8. insulin lispro protam & lispro 100 unit/ml (75-25) insulin pen sig: twenty (20) units subcutaneous before dinner. 9. labetalol 200 mg tablet sig: two (2) tablet po twice a day. disp:*120 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: non st elevation myocardial infarction hypertensive urgency acute on chronic diastolic dysfunction chronic kidney disease diabetes mellitus type 2 discharge condition: stable. discharge instructions: you have very high blood pressure that caused your heart to be enlarged and stiff. your uncontrolled blood pressure caused a heart attack with some heart damage. it is of the utmost importance that your blood pressure be well controlled to prevent further heart damage. please get a blood pressure cuff at home and check your blood pressure every day at different times. keep a log of these blood pressures and bring with you to every doctor's appt. you may be set up with a home telemonitoring system that will send your weights and blood pressures to your doctor's office. please also check your blood sugars daily to see if your insulin needs to be adjusted. you will need to see dr. in a few weeks to check your heart status and he recommend that you go to cardiac rehabilitation near your home. this will help with exercise and will give you information about your diet. new medicines: 1. labetolol: to lower your blood pressure 2. furosemide: to lower your blood pressure and prevent build up of fluid in your lungs. 3. amlodipine: to lower your blood pressure 4. simvastatin: to lower your cholesterol and keep your heart arteries from further narrowing and causing another heart attack. 5. nitroglycerin: to take if you have chest pain at home. take 5 minutes apart while you are sitting down. if you still have chest pain after 3 doses, call 911. . please call dr. or dr. if you have any chest pain, trouble breathing, low blood pressure, fevers, dizziness or any other unusual symptoms. please get a blood pressure cuff at home and check your blood pressure daily, keep a log to give to your doctors at office . please call if you have any questions about your medicines or discharge. followup instructions: primary care: , e. date/time: friday at 1:30pm. . cardiology: provider: phone: clinical center, date/time: 3:40 procedure: coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization aortography diagnoses: subendocardial infarction, initial episode of care pure hypercholesterolemia congestive heart failure, unspecified acute on chronic diastolic heart failure diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes chronic kidney disease, stage iii (moderate) long-term (current) use of insulin osteoporosis, unspecified osteitis deformans without mention of bone tumor diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled acquired absence of both cervix and uterus other second degree atrioventricular block atherosclerosis of other specified arteries osteoarthrosis, localized, not specified whether primary or secondary, lower leg other cataract hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage i through stage iv, or unspecified nonproliferative diabetic retinopathy nos 

Answer: The patient is high likely exposed to