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: history of present illness: this is a 46-year-old woman was transferred in from an outside hospital for emergent cardiac catheterization with a known history of coronary artery disease and a history of cerebrovascular accidents in and . the patient presented to an outside hospital with chest pain and was found on cardiac catheterization to have a 90% in-stent re-thrombosis of the left anterior descending artery, a subtotal first obtuse marginal occlusion of the circumflex, and a diffuse right coronary artery disease. she arrived from the outside hospital with a blood pressure of 86/44 and was placed on an intra-aortic balloon pump. after cardiac catheterization in the laboratory, she denied any worsening of her chronic left arm weakness. she had prior stenting done on with stenting and percutaneous transluminal coronary angioplasty of the lower pole of the first obtuse marginal and percutaneous transluminal coronary angioplasty of the upper pole. after cardiac catheterization, as the patient was in cardiogenic shock she was transferred to the coronary care unit. past medical history: 1. coronary artery disease; status post first obtuse marginal stenting to the first obtuse marginal and to the left anterior descending artery with re-thrombosis of the stents. 2. moyamoya disease. 3. history of cerebrovascular accidents in and . 4. history of right carotid endarterectomy. 5. history of right carotid to middle cerebral artery bypass. 6. hypertension. 7. insulin-dependent diabetes mellitus. 8. peripheral neuropathy. 9. elevated lipids. 10. history of cholelithiasis. 11. history of seizures. 12. recent infection of the left toe with a question of osteomyelitis. medications on admission: 1. aspirin 325 mg by mouth once per day. 2. plavix 75 mg by mouth once per day. 3. nitroglycerin as needed. 4. enalapril 5 mg by mouth once per day. 5. toprol-xl 50 mg by mouth once per day. 6. lipitor 10 mg by mouth once per day. 7. insulin (70/30 mix) 40 units in the morning and 30 units in the evening. 8. metformin 850 mg by mouth twice per day. allergies: she is allergic to sulfa. social history: she previously smoked one pack per day but quit; the date is not noted. brief summary of hospital course: one week prior to her admission, she had increasing episodes of substernal chest pain while visiting her husband at the outside hospital where he was being treated for a burn. ultimately, her chest pain increased. she had electrocardiogram changes, and she ruled in for a myocardial infarction with a troponin of 1.04. she was transferred into for that reason for immediate cardiac catheterization. she remained in the cardiothoracic intensive care unit for monitoring with her intra-aortic balloon pump. she was in a normal sinus rhythm. the cardiology service also considered possibly doing risk stratification for her for an automatic internal cardioverter-defibrillator placement given her myocardial infarction and low ejection fraction. a neurology consultation was obtained for her history of moyamoya disease for neurologic risk assessment pending the possibility of either neurosurgical vascular shunt or coronary surgery. laboratories on admission were as follows. her white blood cell count was 13.4, her hematocrit was 31.4, and her platelet count was 423,000. her prothrombin time was 13, her partial thromboplastin time was 24, and her inr was 1.2. sodium was 138, potassium was 3.8, chloride was 97, bicarbonate was 29, blood urea nitrogen was 15, creatinine was 0.7, and her blood glucose was 82. her magnesium was 1.4, her phosphate was 4.9, and her calcium was 9.2. her creatine kinase was 91 and a positive troponin. cardiology also adjusted the balloon for more accurate placement upon notification of radiology status post a chest x-ray. the patient was also started on lasix for diuresis and a heparin drip. she remained on an insulin sliding-scale and continued with beta blockade. the patient was seen by the stroke service. dr. of cardiothoracic surgery also was consulted with a desire to know what the risks of hemorrhage were as systemic heparinization would be required to put the patient on pump for bypass. the neurologic examination was stable. the magnetic resonance imaging showed negative for old hemorrhage and positive for an old right stroke. please refer to their note. the patient was also seen by the neurosurgery team in consultation who recommended the possibility of the patient benefiting from cerebral angiography to start to clarify the risk of a neurologic insult during surgery. on the patient was seen by dr. of cardiothoracic surgery who noted her history as above. neurologically, she was alert and oriented. the acic bypass and stent was patent per magnetic resonance angiography, and her right cortex was well collaterized from the left. he noted this as well as appreciating the neurology service and stroke service consultations. on examination, she was alert and oriented. cranial nerves ii through xii were grossly intact with a negative neurologic examination. her lungs were clear bilaterally. she had decreased breath sounds on the left side, however. she had normal first heart sounds and second heart sounds. she had a positive early systolic murmur. her chest was symmetric. her abdomen was obese, soft, nontender, and nondistended. her lower extremities were cool to touch but positive capillary refill, and no venous stasis changes. no dorsalis pedis pulse was appreciated at that time. preoperative, her potassium was 3.8, with a blood urea nitrogen of 12, and a creatinine of 0.5. her prothrombin time was 13.8. her inr was 1.3. clearly, the patient had failed her percutaneous transluminal coronary angioplasty interventions. her noted her coronary targets, and the patient consented to coronary artery bypass graft. the patient was also started on an ace inhibitor, captopril 25 mg three times per day while she remained in the coronary care unit. she was also screened for nutrition risk. a preoperative workup was done on . the urinalysis also showed some hematuria. a chest x-ray showed bilateral pleural effusions (left greater than right), but no congestive heart failure or infiltrates. on , the patient underwent coronary artery bypass grafting times four by dr. with a left internal mammary artery to the left anterior descending artery, vein graft to the posterior descending artery, sequentially to the posterolateral branch, and a vein graft to the second obtuse marginal. she was transferred to the cardiothoracic intensive care unit in fair condition on a dobutamine drip at 5 mcg/kg per minute, a levophed drip at 0.75 mcg/kg per minute, as well as insulin and propofol drips titrated. on postoperative day one, dobutamine was weaned off. levophed was at 0.15 mcg/kg per minute. the balloon remained on 1:1 with a blood pressure of 113/68. she was saturating 96%. she had been extubated overnight. in sinus tachycardia at 118. white blood cell count was 14.5. her hematocrit was 33.6. her inr was 1.1. her potassium was 4.6. her blood urea nitrogen was 8. her creatinine was 0.5. she was awake. she had coarse bilateral breath sounds. the rest of her examination was relatively benign with the exception of having to doppler both dorsalis pedis and posterior tibialis pulses bilaterally as her feet were slightly cool somewhat to preoperatively. she began lasix diuresis. she was continued on her perioperative antibiotics. she was followed by the cardiology fellow who noted some episodes of recurrent ventricular tachycardia. diuresis was continued. there was a concern with her electrocardiogram changes and recurrent runs of ventricular tachycardia about possibly taking her back to the catheterization laboratory, but this was not done at that time. overnight on postoperative day two, her chest tubes and intra-aortic balloon pump were discontinued. she was restarted on plavix. she remained in a sinus tachycardia at 100 with a blood pressure of 105/56. she was saturating 96% on 2 liters. she was awake and alert. she was responsive. her chest x-ray showed that she was very wet. her incisions were clean, dry, and intact. neurologically, she had no issues at this time. she was continued on lopressor and restarted on plavix. lasix diuresis continued with 20 mg three times per day. she was seen by case management who continued to follow her. the patient was also seen by physical therapy. on , the patient developed some respiratory insufficiency. anesthesia was called to re-intubate the patient over respiratory distress, which was done on . the patient did go back to the catheterization laboratory on . the left internal mammary artery to the left anterior descending artery was patent, and the vein grafts to right coronary artery sequentials and first obtuse marginal were patent. of note, during the catheterization and interventions it was noted that the vein graft to the first obtuse marginal had some distal valve torsion. please refer to the cardiac catheterization report. a stent was placed across the saphenous vein graft lesion. the patient also had torsade and was defibrillated three times in the cardiac catheterization laboratory. the patient then returned to the cardiothoracic intensive care unit on and was extubated. she was sitting in her chair and doing well with no complaints. her chest x-ray showed improved congestive heart failure. her white blood cell count rose to 17.9 with a hematocrit of 27.6. her platelets were 261,000. her blood urea nitrogen was 9. her creatinine was 0.5. she was stable and off pressors at that time. she was continued on telemetry observation with the need probably to consider electrophysiology and implantable cardioverter-defibrillator placement prior to discharge. on postoperative day four, she remained on a heparin drip and a neo-synephrine drip at 1 mcg/kg per minute. she was saturating 100% on 2 liters nasal cannula. she was in a sinus rhythm in the 70s with a blood pressure of 110/54. she was alert and oriented. she had no other change in her examination with plans to continue weaning off the neo-synephrine. she remained in the cardiothoracic surgery recovery unit. she was seen and evaluated by physical therapy again. she was still requiring neo-synephrine support at that time. on postoperative day five, she had a blood pressure of 115/51. she remained in a normal sinus rhythm. she was saturating 100% on room air with heparin going at 1500 and neo-synephrine at 0.5. she also continued on amiodarone 400 mg three times per day as her antiarrhythmic, and lopressor 12.5 mg twice per day, as well as aspirin and plavix. her neurologic examination was stable. her right leg was starting to bother her, and a vascular surgery consultation was called on for intermittent loss of the right foot signals on right foot modeling with second toe on the right foot blue and loss of dopplerable signals. the patient had been heparinized for two days at that point. she noted that this was the toe ulceration with cellulitis approximately one week prior to admission which was noted on her history. vascular surgery recommended that anticoagulation with coumadin was not indicated at that time but that ultimately a left lower extremity angiography would have to be performed. the patient was seen by dr. who recommended no present indication for intervention at this time and to be conservative for the time being as the patient probably had a bilateral superficial femoral artery and tibial artery disease. on postoperative day five, the plan was for the patient to possibly get an implantable cardioverter-defibrillator that day. she remained on lasix, lopressor, amiodarone, plavix, aspirin, and had positive dopplerable signals both dorsalis pedis and posterior tibialis bilaterally. she was hemodynamically stable. she received one unit of packed red blood cells blood transfusion. her hematocrit rose to 29. her creatinine remained stable at 0.5. she was followed by the neurology service. on , she went back to the electrophysiology laboratory. the electrophysiology study was negative. no ventricular tachycardia could be induced at that time. she was transferred to two on where she started to work with physical therapy. she had no complaints. on , she had a blood pressure of 108/55. she remained afebrile. she was in no distress. her lungs were clear bilaterally. her wounds were clean, dry, and intact. she had some 1+ edema in the extremities. her right inguinal area had no bleeding or growth of any hematoma status post her sheath removal from cardiology. the plan was to continue to have the patient ambulate. she was seen by case management who continued to work with physical therapy and nurses on that ambulation so that she could be discharged to home. she developed a little bit of serous drainage from her sternal incision. an occlusive dressing was applied as well as betadine wash. the wires were discontinued on . the patient complained of just incisional and neuropathy pain and received percocet with some relief of that while she was on the floor on and 26 as we monitored her sternal drainage. she did remain stable on . she had an unremarkable examination with sparse drainage from her sternal wound and no click. otherwise, her incisions looked good. she was started on levaquin for her wound drainage with a plan to try and discharge her on , but that did not occur. she continued to work with physical therapy and had some issues with pain management. she had a small amount of drainage on . she had bilateral peripheral pulses by doppler. she was saturating 96% on room air. she had some decreased breath sounds at the bases. she was tolerating oral intake well. she was alert and oriented. discharge disposition: it was decided to discharge home with services to monitor her chest wound and to allow her to get out of the hospital at that point. discharge instructions/followup: she was instructed to follow up with dr. in four weeks and to follow up with her cardiologist (dr. ) within one week and to see her primary care physician. medications on discharge: (she was discharged on the following medications) 1. metoprolol 12.5 mg by mouth twice per day. 2. aspirin 325 mg by mouth once per day. 3. amiodarone 400 mg by mouth once per day. 4. lipitor 10 mg by mouth once per day. 5. plavix 75 mg by mouth once per day. 6. metformin 850 mg by mouth twice per day. 7. percocet 5/325 mg one to two tablets by mouth as needed q.4h. (for pain). 8. levofloxacin 500 mg by mouth every day (times seven days). 9. lasix 20 mg by mouth twice per day. 10. potassium chloride 20 meq by mouth twice per day. 11. colace 100 mg by mouth twice per day. discharge diagnoses: 1. status post coronary artery bypass grafting times four. 2. status post cardiogenic shock with myocardial infarction. 3. status post intra-aortic balloon pump placement. 4. hypertension. 5. status post prior coronary artery stenting. 6. dyslipidemia. 7. status post right carotid endarterectomy. 8. status post right carotid middle cerebral artery bypass. 9. insulin-dependent diabetes mellitus. 10. history of seizures. 11. history of cholelithiasis. 12. status post cerebrovascular accident times two in and . discharge status: the patient was discharged to home with services on . , m.d. dictated by: medquist36 procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters coronary arteriography using two catheters left heart cardiac catheterization diagnostic ultrasound of heart other and unspecified coronary arteriography other electric countershock of heart catheter based invasive electrophysiologic testing implant of pulsation balloon insertion of drug-eluting coronary artery stent(s) diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified cardiac complications, not elsewhere classified moyamoya disease paroxysmal ventricular tachycardia cardiac arrest cardiogenic shock other complications due to other cardiac device, implant, and graft 

Answer: The patient is high likely exposed to