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: penicillins / zestril attending: chief complaint: left lower extremity ischemia with tissue loss major surgical or invasive procedure: cardiac catherization with stent left femoral to peroneal bypass grafting with in-situ vein graft, angioscopy, valve lysising left abobove knee amputation bedside swallowing evaluation history of present illness: pt's chart is thinned 78 y.o. female whom presented with an ischemic left foot past medical history: diabetes mellitus hypertension peripheral vascular disease hyperlipidemia impaired vision overweight positive ppd anemia health maintenance coronary artery disease cva hypertension social history: denies nicotine use, alcohol use, and drug use. family history: not known physical exam: a/o x 2 nad ncat, perrl, eomi neg lesions nares, oral pharnyx, auditory neg supraclavicular nodes, supple, farom lungs cta b/l with slight crackles at bases rrr without murmers obese, nttp, nd, pos bs, neg cva tenderness foley to gravity l aka wound c/d/i good fem pulse at 2 plus r 2 plus fem / dp / pt pertinent results: wbc-14.8* rbc-3.53* hgb-10.1* hct-31.4* mcv-89 mch-28.6 mchc-32.2 rdw-14.5 plt ct-504* pt-13.6 ptt-35.6* inr(pt)-1.2 glucose-53* urean-21* creat-0.8 na-149* k-3.4 cl-113* hco3-32* angap-7* calcium-8.8 phos-4.0 mg-2.1 ecg study date of sinus tachycardia and occasional ventricular ectopy. lead v3 was not obtained. wandering baseline. slight st segment depressions in leads v5-v6. in the context of poor quality ecg, repeat tracing of diagnostic quality is suggested. the rate has increased as compared to the previous tracing of , and except for ventricular ectopy, there is no diagnostic interim change. chest (portable ap) chest: the heart is enlarged and unwinding of the aorta is present. upper zone redistribution, suggesting some failure is present. the tip of the right ij line lies in the lower svc. the tip of the nasogastric tube lies within the stomach. comparison with the prior film shows some improvement in the degree of failure. impression: failure persists, but improved since . line in satisfactory position cardiology report echo study date of measurements: left atrium - long axis dimension: 3.4 cm (nl <= 4.0 cm) left atrium - four chamber length: *5.8 cm (nl <= 5.2 cm) right atrium - four chamber length: *5.7 cm (nl <= 5.0 cm) left ventricle - ejection fraction: 45% to 50% (nl >=55%) aorta - valve level: 3.4 cm (nl <= 3.6 cm) aortic valve - peak velocity: 1.8 m/sec (nl <= 2.0 m/sec) mitral valve - e wave: 1.1 m/sec mitral valve - a wave: 1.3 m/sec mitral valve - e/a ratio: 0.85 mitral valve - e wave deceleration time: 235 msec tr gradient (+ ra = pasp): *40 mm hg (nl <= 25 mm hg) interpretation: findings: left atrium: elongated la. right atrium/interatrial septum: mildly dilated ra. a catheter or pacing wire is seen in the ra. left ventricle: symmetric lvh. normal lv cavity size. mildly depressed lvef. lv wall motion: regional lv wall motion abnormalities include: basal inferolateral - hypo; mid inferolateral - hypo; right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic root diameter. aortic valve: mildly thickened aortic valve leaflets. no ar. mitral valve: mildly thickened mitral valve leaflets. moderate mitral annular calcification. mild (1+) mr. tricuspid valve: moderate to severe tr. moderate pa systolic hypertension. pericardium: no pericardial effusion. conclusions: the left atrium is elongated. there is symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed. resting regional wall motion abnormalities include inferolateral hypokinesis. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. c.cath brief history: this is a 73 year old woman with a history of diabetes mellitus, hypertension, and dyslipedemia who was referred for a heart catheter because of a nstemi. she underwent left cfa-popliteal bypass . postoperatively she developed respiratory failure and required intubation. her cardiac markers became elevated with a ckmb of 34 and troponin of 0.68. the echocardiogram showed hypokinesis of the inferolateral wall. the ejection fraction was estimated to be 45-50%. the resting ekg showed sr and non-spec. st-t-wave changes laterally. indications for catheterization: nstemi **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca discrete 90 2) mid rca discrete 90 2a) acute marginal normal 3) distal rca discrete 100 4) r-pda diffusely diseased 4a) r-post-lat diffusely diseased **arteriography results morphology % stenosis collat. from **left coronary 5) left main normal 6) proximal lad diffusely diseased 6a) septal-1 normal 7) mid-lad diffusely diseased 60 8) distal lad diffusely diseased 9) diagonal-1 diffusely diseased 10) diagonal-2 diffusely diseased 12) proximal cx normal 13) mid cx normal 13a) distal cx normal 14) obtuse marginal-1 normal 15) obtuse marginal-2 discrete 90 16) obtuse marginal-3 diffusely diseased ptca comments: we elected to treat the om with ptca/stenting using heparin and integrilin prophylactically. the sheath was upsized to 7 french, and a 7 french xb 3.5 guide provided good support. a pt intermediate wire crossed into the lower pole, and a wizdom ss wire crossed into the upper pole. a 2.0 x 15 mm voyager was used to predilate the lower pole at 10 atm twice, and was also used to predilate the upper pole at 12 atm. the lower pole wire was removed, and the upper pole was stented with a 2.5 x 18 mm hepacoat at 14 atm. the stent was then post-dilated with a 2.75 x 13 mm highsail at 18 atm twice. final angiography demonsrated no dissection, no residual stenosis within the upper pole with a moderate residual in the lower pole, and timi-3 flow in both branches. comments: 1. selective coronary angiography showed aright dominant system with three vessel disease. the lmca was without flow limiting stenoses. the lad was diffusely diseased with up the 60% stenosis in the mid segment. the lcx filled a high om1 which did not have flow limiting stenoses. the om2 was a large vessel and had a 90% stenosis at the bifurcation into a large upper and a small lower branch. the rca was diffusely diseased with 90% proximal, 90% mid and 100% mid occlusion. the diastal rca filled via left to right collaterals. 2. limited resting hemodynamics showed moderately elevated right and left sided filling pressures (ra mean 12 mmhg, rvedp 20 mmhg, pcw mean 22 mmhg). there was moderate pulmonary hypertension (pa mean 35 mmhg). the cardiac output was normal (co 6.1 l/min, ci 2.6 l/min/m2). 3. successful pci of the upper pole of the om with a 2.5 x 18 mm hepacoat stent, post-dilated with a 2.75 mm balloon. the lower pole of the om was dilated with a 2.0 mm balloon. final diagnosis: 1. three vessel coronary artery disease. 2. moderate diastolic ventricular dysfunction. 3. moderate pulmonary hypertension. 4. successful pci of the om. brief hospital course: pt had a complicated hospital stay chart is thinned pt admitted on for left lower extremity ischemia with tissue loss pt pre - op'd for procedure. pt underwent a left femoral to peroneal bypass grafting with in- situ vein graft, angioscopy, valve lysis. pt tolerated the procedure well. there were no complications. pt was transfered to the pacu in stable condition. because of the following listed below pt was transfered to the sicu #1 resp failure/intubated/chf- likely 2ndary to htn, tachycardia, fluid resusc likely in setting of pulm htn, diast/syst dysfxn. #2 hypotension- likely secondary to mixed cardiogenic and septic physio. svr low with nl ci but high filling pressures. febrile with high wbc. since ci is not supra normal suspect some mycoardial depression. also has phtn. #3 nsvt- likely secondary to electrolyte changes, catechols, stress of illness, and ischemia. #4 nstemi- likely demand secondary to sepsis, tachy, chf, htn. pt recieved echo tte: with ef 45-50, basal inferior hk, 1+ tr, 3+tr, mod pulm htn. - trop up but ck-mb rising. pa numbers very septic looking (high ci, low svr). on bb, getting diuresed. sputum growing gpc/gnr/gpr. put on antibiotics. pt extubated. trop coming down. heart rate still high and will encourage bb po. still with fevers. still febrile with leukocytosis. trop less but still elevated. hr still increased, encouraged bb pt for cardiac cath with pcw 22, to rca, 60% lad, 90% om s/p om hepacoat still tachy and septic, volume overloaded with mental status changes. nivs showed bpg closed, this with pts sepsis warranted l aka> pt undergoes left aka. tolerated the procedure well. recovered from anesthesia without complications. transfered back to the sicu in stable condition. pt status started to improve. pt did recieve prbc for low hct post op. cardiology feels that she is stable enough to sign off. pts creat increase secondary to hypovolemia. pt fluid replaced creat improved. - pt remained in sicu. pt's staus improved. pt started to take po, was able to get oob to chair. lines were changed pt transfered to vicu. here her diet was advanced as tolerated. she is taking po's. on discharge. her foley was changed. pt is making urine, but foley will remain untill pt is mobile. she is able to get oob to chair with asst. pt to get rehab screen on discharge, central line is , pt has foley - making urine. she is taking po but needs encouragement. she is able to mobilize with great help. her mental status is appropriate. medications on admission: asa 325, avandia 8', cozaar 200', humulin 36/15, hctz 25', lactulose 15', lipitor 20', metformin 850", nicardipine 30 discharge medications: 1. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 2. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 3. atorvastatin calcium 10 mg tablet sig: one (1) tablet po daily (daily). 4. acetaminophen 160 mg/5 ml elixir sig: one (1) elixir po q4-6h (every 4 to 6 hours) as needed for fever. 5. aspirin ec 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 6. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). 7. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 8. metformin hcl 850 mg tablet sig: one (1) tablet po bid (2 times a day). 9. gabapentin 250 mg/5 ml solution sig: one (1) po q24h (every 24 hours). 10. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed. 11. rosiglitazone maleate 2 mg tablet sig: three (3) tablet po daily (daily). 12. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 13. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). 14. metoprolol tartrate 50 mg tablet sig: three (3) tablet po tid (3 times a day). 15. insulin please see attached sheet for insulin dosing 16. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 17. cozaar 100 mg tablet sig: two (2) tablet po once a day. 18. nicardipine hcl 30 mg capsule sig: one (1) capsule po twice a day. discharge disposition: extended care facility: - discharge diagnosis: left lower extremity ischemia with tissue loss resulting - left femoral to peroneal bypass grafting with in-situ vein graft, angioscopy, valve lysising then eventually l aka post op chf mi - cardiac cath - stentin of arf discharge condition: stable discharge instructions: keep surgical wound clean, dry and intact. check for signs of infection, warmth over area, discharge from wound and redness or swelling. also check for signs od systemic infection. fever, chills and sweats. if this happens please call dr. office immediatly. pt also has stage 2 decubitus ulcer. please see wound care instructions. followup instructions: call dr office at to make appointment for two weeks. call cardiology at to make appointment. pt is post operative from a stent provider: , where: phone: date/time: 8:40 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of platelet inhibitor insertion of endotracheal tube enteral infusion of concentrated nutritional substances other (peripheral) vascular shunt or bypass arterial catheterization amputation above knee transfusion of packed cells injection or infusion of nesiritide insertion of drug-eluting coronary artery stent(s) diagnoses: subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis cardiac complications, not elsewhere classified primary pulmonary hypertension urinary complications, not elsewhere classified atherosclerosis of native arteries of the extremities with gangrene acute osteomyelitis, ankle and foot chronic osteomyelitis, ankle and foot 

Answer: The patient is high likely exposed to