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: nstemi major surgical or invasive procedure: cardiac catheterization history of present illness: the patient is a 68 yo man with h/o cad s/p cabg in , who presented with 12 hour history of chest pain and was transferred to for cardiac catheterization. the patient states that he began to experience chest pain last night at approximately 5 pm, when he was laying in bed. the pain was an , substernal, non-radiating sharp pain. he also experienced associated shortness of breath and nausea. the patient states that he believes he lost consciousness after this event and then woke up multiple times throughout the night with similar chest pain. when he woke up this morning at 5 am, he continued to experience the pain, so he called ems. he was found to have a fsbg of 46. he was then brought to hospital for further evaluation. . in the ed, his vs were t 98.7, p 101, r 24, bp 124/99, o2 97% on ra. he had an ecg which showed st depressions in ii, iii, avf, v4-v6 and twis in v4-v6. cardiac enzymes were drawn and were found to be elevated (ck , troponini 60.83). he was given asa 325 mg, plavix 300 mg, zofran for nausea, and was started on heparin gtt. he was then transferred to for cardiac catheterization. . in the cath lab, the patient was found to have known severe 3vd. his lima-lad graft was patent but had moderate diffuse disease and distal collaterals. his other three sv grafts were all occluded at the origins, and one of the om grafts appeared to be newly occluded. it was thus decided that the patient would undergo medical management of his cad. . on arrival to the floor, the patient is no longer experiencing chest pain. he states that he is short of breath and has a productive cough, which has been present for the past three days. of note, the patient states that he also lost consciousness five days ago while at home and believes that his shortness of breath began at this time. . on review of systems, 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. he denies recent fevers, chills or rigors. 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 dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, palpitations, syncope or presyncope. he does endorse a recent increase in his peripheral edema (2 months). past medical history: 1. cabg: 4 vessel cabg in . lima to lad, sv to om1, sv to om2, sv to posterior descending coronary artery. 2. type 2 diabetes, diagnosed 14 years ago 3. hypertension 4. obstructive sleep apnea social history: the patient currently lives with his 20 year old daughter in , ma. he is a retired army . he has never smoked, does not drink, denies any illicit drug use. family history: the patient has an extensive family history of cad. his mother and father both had mis in their 70s and multiple aunts and uncles also had mis. physical exam: vs: t 97.8, bp 109/76, hr 76, rr 16, o2 sat 98% on 2l general: elderly man, pleasant, in nad. aao x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. left eyelid and surrounding tissue appeared edematous. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvd to angle of mandible with prominent a waves. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, fixed split s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: poor inspiratory effort secondary to coughing. fine bibasilar crackles bilaterally. no chest wall deformities, scoliosis or kyphosis. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: 1+ edema in lower extremities bilaterally. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ pertinent results: admission labs: cbc: wbc 11.9, hgb 13.3, hct 40.4, plt 165k bmp: na 136, k 4.4, cl 101, co2 25, glucose 153, bun 24, cr 1.6 ca 9.0 ldh: 603 ast: 164 alt: 43 tbili: 1.7 cpk: , troponini: 60.83 cardiac cath (): 1. coronary angiography in this right dominant system demonstrated three vessel disease. the lmca had diffuse disease on angiographical examination. the lad had a total occlusion at the origin on angiography. the cx had a total occlusion at the origin on angiography. the ramus had an 80% occlusion at the origin on angiography and also had diffuse disease throughout. the rca had a 100% occlusion in the mid portion of the vessel on angiography. 2. arterial condui angiography revealed the lima to be widely patent and if feeds the lad which subsequent collaterals to the rca and the cx. on angiography of the lima, moderate diffuse disease of the lad was noted. all three svg grafts are occluded at the origin with thrombus present within one of the vein grafts. 3. resting hemodynamics revealed elevated right and left sided filling pressures with an rvedp of 13 mmhg and a pcwp of 28 mmhg. there was severe pulmonary arterial systolic hypertension with pasp of 72 mmhg. the cardiac index was low at 1.7 l/min/m2. central aortic pressure was 109/74 mmhg. the svr was increased at 1624 dynes-sec/cm5 and the pvr was increased at 447 dynes-sec/cm5. tte (): the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is severe regional left ventricular systolic dysfunction with anterior, lateral, septal and apical akinesis. there is moderate hypokinesis of the remaining segments (lvef = 15-20%). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. right ventricular chamber size is normal. with focal hypokinesis of the apical free wall. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. there are filamentous strands on the aortic leaflets consistent with lambl's excresences (normal variant). the mitral valve leaflets are structurally normal. moderate (2+) mitral regurgitation is seen. there is no pericardial effusion. pertinent labs: ck(cpk)-1358 ck-mb-54* mb indx-4.0 ctropnt-4.12* alt-41* ast-146* ld(ldh)-824* alkphos-98 totbili-1.2 ck(cpk)-677 ck-mb-19* mb indx-3.4 ctropnt-4.43* alt-38 ast-73* alkphos-101 totbili-1.0 ck(cpk)-265 ck-mb-8 ctropnt-4.06* discharge labs: : blood wbc-7.1 rbc-3.35* hgb-11.0* hct-32.0* mcv-95 mch-32.7* mchc-34.3 rdw-16.7* plt ct-220 : blood pt-14.6* ptt-32.4 inr(pt)-1.3* : blood glucose-120* urean-27* creat-1.4* na-135 k-4.1 cl-100 hco3-26 angap-13 : blood ck(cpk)-265* : blood ck-mb-8 ctropnt-4.06* : blood calcium-8.4 phos-2.9 mg-2.1 : blood triglyc-71 hdl-39 chol/hd-3.6 ldlcalc-89 brief hospital course: 68 year old male with history of cabg in presents with nstemi s/p cardiac cath. no intervention could be done, so patient will continue with medical management. # coronary artery disease: the patient initially presented with a 12 hour history of chest pain, elevated cardiac enzymes, and st depressions in the inferior leads and v2-v4. on cardiac cath, he was found to have occluded sv grafts to the oms, and one of the grafts appeared to be acutely thrombosed. he is not a surgical or pci candidate, and it was determined that he will be medically managed. he was continued on asa 325mg po daily and plavix 75mg po daily. he was started on atorvastatin 80mg po daily (lipid panel tot chol 142, trigly 71 hdl 39, ldl 89), but this was changed to pravastatin 40mg po daily due to leg cramping with atorvastatin. he was started on carvedilol at one point during his stay, but he dropped his blood pressures after each dose. therefore, he was switched to metoprolol. when he blood pressures stabilized, he was started on imdur 30mg po daily in an effort to reduce right-sided pressures. he intermittently experienced chest pain throughout his admission. each time, his pain resolved quickly with sl nitro or morphine. during these episodes, he had no ecg changes and his cardiac enzymes continued to trend down. he had a follow-up echo that showed a dilated left ventricle with severe regional systolic dysfunction, c/w multivessel cad. there was moderate regional right ventricular systolic dysfunction and moderate mitral regurgitation. a previous echo in showed similar apical akinesis and therefore it was felt that anticoagulation to prevent lv thrombus was not indicated. he will be transitioned to metoprolol succinate xl 25 mg daily and is to remain on a proton pump inhibitor, pantoprazole 40 mg daily as he has a history of gi bleeding and will need to remain on aspirin and plavix. # acute on chronic congestive heart failure: he does not have a history of chf, but he had extremely high ra, pa, pcwp on cardiac catheterization. he was actively diuresed during his stay with a lasix gtt, and then he was started on lasix 60mg po daily. he was started on digoxin 0.125mg po daily as well. # rhythm: the patient presented in normal sinus rhythm and remained in this rhythm for much of his stay. he did have occasional runs of non-sustained vtach, likely related to reperfusion. # acute on chronic renal failure: patient was diuresed a significant amount during his stay, and his creatinine bumped to 2.1 during this admission. at discharge, it had resolved back to 1.4. his acute renal failure was felt to be due to a prerenal etiology. # diabetes mellitus type 2: metformin and glyburide were held in the setting of increasing creatinine and recent contrast administration. he was maintained on a sliding scale insulin regimen with humulog and glargine. the patient experienced some low blood sugars, and his insulin dosing has been reduced compared to his outpatient regimen. he will be discharged on a lower dose of insulin compared to his outpatient dosing. it is advised he follow up with his pcp soon for further management of his diabetes. also, upon discharge he was changed from glyburide to glipizide. since glyburide is renally cleared, and the patient has a recent history of acute on chronic renal failure, it was felt that glipizide would be a better sulfonylurea, as it is hepatically cleared. he is to re-start his metformin upon discharge. #dysphagia: patient has a chronic history of coughing. it was noted that choking occurred upon eating his meals and with a concern for aspiration, a speech and swallow evaluation was performed. recommendations included a po diet of thin liquids and regular solids. patient is encouraged to select soft foods. recommend gi consult for further evaluation of upper esophageal sphincter and candidacy for dilation. patient is to follow up in the outpatient setting for further evaluation. he had no signs of aspiration during his hospital stay. #obstructive sleep apnea: patient has history of osa, but has never had a sleep study or used a cpap machine. during his hospital stay, he had numerous episodes of apnea at night along with desaturating oxygen levels into the 80s. he was placed on a cpap machine which ameliorated his symptoms. it is advised he have a sleep study in the outpatient for further management of this problem. # disposition: physical therapy saw the patient and felt that he would benefit from rehabilitation. he is to be discharged to a rehab facility. medications on admission: benzonatate 200 mg capsule 1 capsule(s) by mouth twice a day furosemide 40 mg tablet 1 tablet(s) by mouth once a day furosemide 20 mg tablet 1 tablet(s) by mouth once a day total of 60 mg qd glyburide 5 mg tablet 2 tablet(s) by mouth twice a day insulin glargine 100 unit/ml solution 65u once a day lisinopril 20 mg tablet 1 tablet(s) by mouth once a day metformin 1,000 mg tablet 1 tablet(s) by mouth once a day potassium chloride 20 meq tab sust.rel. particle/crystal one tab(s) by mouth daily ranitidine hcl 150 mg tablet one tablet(s) by mouth twice a day insulin nph & regular human 100 unit/ml (70-30) suspension prn prn discharge medications: 1. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. nitroglycerin 0.3 mg tablet, sublingual sig: tablet, sublinguals sublingual prn (as needed) as needed for chest pain. 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: five (5) ml po q6h (every 6 hours) as needed for cough. 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 7. pravastatin 40 mg tablet sig: one (1) tablet po once a day. 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) syringe injection twice a day. 9. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 10. furosemide 20 mg tablet sig: three (3) tablet po daily (daily). 11. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 12. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 13. docusate sodium 100 mg capsule sig: two (2) capsule po twice a day. 14. polyethylene glycol 3350 100 % powder sig: one (1) packet po daily (daily). 15. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 16. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 17. glipizide 5 mg tablet sig: one (1) tablet po bid (2 times a day). 18. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). discharge disposition: extended care discharge diagnosis: non st elevation myocardial infarction acute on chronic systolic congestive heart failure mild dysphagia discharge condition: stable vss discharge instructions: you had a heart attack and a cardiac catheterization that showed severe coronary artery disease. the decision was made that the best treatment was to optimize your medicines to help your heart beat better and prevent another heart attack. we made the following changes to your medicines: 1. lisinopril was decreased to 2.5 mg. 2. metoprolol was started to help your heart recover from the heart attack. 3. plavix and aspirin was added to prevent blood clots and another heart attack. 4. imdur was started to prevent chest pain 5. glyburide was changed to glipizide. 6. ranitidine was changed to pantoprazole to protect your stomach 7. metformin, benzonatate and 70/30 insulin was discontinued 8. pravastatin was started to lower your cholesterol . weigh yourself every morning, md if weight > 3 lbs in 1 day or 6 pounds in 3 days. adhere to 2 gm sodium diet fluid restriction: 1500cc/day followup instructions: primary care: , r. phone: please call after you get home to see in the first one to two weeks. . cardiology: , md , phone: ( date/time: monday at 2:40pm . gastroenterology: dr. digestive diseases assoc. , phone: ( date/time: tuesday at 4:00pm procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart diagnoses: obstructive sleep apnea (adult)(pediatric) subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled coronary atherosclerosis of autologous vein bypass graft hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified acute on chronic systolic heart failure dysphagia, unspecified cough 

Answer: The patient is high likely exposed to