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: aleve / lisinopril / heparin agents attending: chief complaint: chest pain major surgical or invasive procedure: - cardiac catherization, angiosculpt balloon & promus to prox ramus history of present illness: 58-yo m w/ cad, ischemic cardiomyopathy (tte ' lvef 30%), stage iii/iv ckd (baseline cr 2.5-3.0), dm2 with neuropathy, htn, hl, copd, osa on bipap, and morbid obesity (366 lbs) who presented to osh w/ transferred to for cardiac cath. his cardiac history began in when he experienced an inferior mi and underwent rca stenting. he developed in-stent restenosis in and had taxus stent placed. in he started developing chest discomfort w/ minimal exertion and even at rest, somewhat improved w/ sl ntg. he presented to the ed in where he r/o for mi. follow-up stress test showed moderate inferolateral and anterolateral ischemia; tte showed lvef 40%. he underwent cardiac cath in at hospital which revealed 50% lad, 70% ramus, 80% lower pole of ramus, and total occlusion of rca and cx. he was referred to dr. for consult regarding potential cabg, but deemed inappropriate for surgery d/t poor targets. he was scheduled to have planned ramus pci on , but patient was admitted to hospital on with chest pain, shortness of breath, and found to be in chf and with elevated troponin, ruled in for nstemi w/ peak of 0.41. he was diuresed and creatinine rose to 4.4. with ivfs, his creatinine improved to 3.9. in the cath lab pt was on bipap, had lower pole of distal ramus dilated w/ 2.5x10mm angiosculpt balloon and prox ramus lesion direct stented w/ promus des. pt transferred to ccu from cath lab for respiratory distress requiring bipap. in ccu, pt is , comfortable, alert and conversant w/ stable vs past medical history: - cad- s/p stenting of rca , s/p taxus stent for isr - mi - ischemic cardiomyopathy lvef 30-35% - ckd stage iii/iv w/ 4g of daily proteinuria, base cr 2.5-3.0 - obesity related glomerulosclerosis - diabetic nephropathy and nephrosclerosis - morbid obesity - insulin dependent diabetes mellitus - hypertension - hyperlipidema - cerebrovascular disease (known occluded right ica) - copd - dilated retinopathy - obstructive sleep apnea(on nocturnal cpap) - thyroid nodule s/p partial thyroidectomy ' - aicd/biventricular pacemaker placement (st. ) - left carotid angioplasty/stent social history: lives with: wife occupation: disabled has 2 daughters, involved in care tobacco: 40 pack year. quit 1 year ago. etoh: rare, infrequent use. family history: brother underwent cabg in his 40's. mother died at 86 with cva/cad. father died at 47 of cerebral hemorrhage physical exam: vs: t: afebrile hr: 76 bp: 137/62 rr: 32 sao2: 99% on bipap settings gen: morbidly obese hirsute middle aged male in nad wearing bipap heent: sclera anicteric. perrl, eomi. mm dry neck: cannot assess jvp 2/2 body habitus cv: soft s1,s2; ii/vi sem @ base chest: posterior exam limited, ant exam clear, on bipap abd: +bs, obese soft, ntnd ext: 2+ pitting edema anterior shins, 2+ dp/pt pulses b/l, r radial dressing c/d/i neuro: a&ox3, no focal neuro deficits pertinent results: cardiac catheterization: 1. coronary angiography of this right dominant system showed 2 vessel coronary artery disease. the lmca and lad had no angiographic flow-limiting disease. the lcx was occluded. the ramus intermedius had an ulcerated proximal 80% stneosis and an origin 80% stenosis of a lower pole. the rca was known occluded and not selective injected. 2. limited resting hemodynamics revealed a central aortic pressure of 144/73 mmhg. 3. successful ptca and placement of a 3.0x23mm promus drug eluting stent in the ramus intermedius were performed. final angiography showed normal flow, no apparent dissection, and no residual stenosis. (see ptca comments.) final diagnosis: 1. ptca and placement of a drug eluting stent in the ramus intermedius. tte: due to very suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef ? 55%). the aortic valve is not well seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. brief hospital course: mr. is a 58 year-old gentleman with cad s/p pci to rca ' c/b in-stent restenosis w/ taxus ', dm2, htn, hl, copd, osa on bi-pap, and morbid obesity s/p catheterization w/ des to ramus, transferred to ccu for management of respiratory distress. 1. respiratory distress: mr. was admitted to the ccu after cardiac cath (details below) due to persistent need for bipap to maintain adequate oxygenation. necessity for bipap likely multifactorial including underlying copd, osa requiring cpap at home, volume overload and possible pneumonia. he was continued on bipap, completed antibiotic course for aommunity acquired pneumonia, and attempted to diurese. initially, his fluid balance was positive and he did not respond to lasix gtt or bolus due to presumed post-contrast atn. after discontinuing lasix gtt, urine output imrpoved temporarily, however, after renal consult lasix gtt was restarted with improved diuresis. he was transitioned to his home cpap at night with intermittant use during the day (alternating with high flow oxygen). his breathing improved with diuresis. when off of bipap, his outpatient copd medications were restarted. his breathing continued to improve over his hospital course with no oxygen requirement during the day and continued cpap usage at night. he was evaluated by pt who cleared him for discharge. his o2 requirement continued to improve and by the time of discharge he was satting 95% on room air, even while ambulating with physical therapy. 2. nstemi/cad: mr. was transferred from an outside hospital for cardiac catheterization in setting of chest pain and ruling in for nstemi by cardiac enzymes. on cardiac catheterization he had des placed to ramus and was chest pain free post-procedure and for rest of admission. continue on high dose aspirin. plavix 75 mg daily started, will need to be continued for 1 year. continued metoprolol and imdur as prescribed as an outpatient. his simvastatin was changed to lipitor 80 mg with no adverse effect, however based on lipid studies, statin was changed back to simvastatin that he took as outpatient. ranexa was continued for angina. echo was very suboptimal post-procedure with limited information interpreted from it, possible lvef of 55%. mr. was previously on /hctz combination, however given his acute renal failure this was held during the course of his admission and no ace-i or other was started. he remained chest pain free for the rest of the admission. 3. acute on chronic renal failure: mr. renal function was impaired on admission with concern for possible new baseline at osh of approx . his creatinine on admission was 3.7 and worsened daily post-catheterization, felt to be consistent with post-contrast atn. initial volume status was positive due to poor urine output. urine output improved with lasix gtt and mr. diuresed steadily. nephrology was consulted and recommended monitoring patient to avoid dialysis. creatinine peaked at 8.3 and trended down there after with good urine output. he was started a phospherus binder during the admission but at time of discharge, it was no longer needed. creatinine continued to trend down and plan at the time of discharge was for pt to f/u with dr. his outpatient nephrologist as soon as possible, ideally early next week. after discussion with the renal team, it was decided that he would restart lasix 120mg po daily on monday . 4. hypertension: mr. was continued on his outpatient medications while admitted - amlodipine, metoprolol, imdur. due to acute on chronic renal failure, diovan was held. in setting of acs, hydralazine was started and titrated as tolerated for optimal blood pressure control. he tolerated this medication well. as he was diuresed, hydralazine was decreased slightly. during later portion of hospitalization, blood pressure parameters were relaxed to keep renal perfusion optimal. 5. diabetes type 2: poorly controlled as hga1c 10%. he was continued on nph 100u qam and qpm during admission, with modifications as needed due to po intake. he was covered with a humalog sliding scale for meals. 6. hypothyroidism: patient is s/p partial thyroidectomy for thyroid nodules in . levothyroxine 50mcg /daily as per outpt dosing was continued in house. medications on admission: mucomyst pre cath lopressor 75mg allopurinol 200mg daily amlodipine 10mg daily isosorbide mononitrate 90mg diovan 320mg daily simvastatin 20mg daily ezetimibe 10mg plavix 75mg aspirin 81mg daily renexa 500mg levaquin 500mg qod (for ? right sided pneumonia, urine + for bacteria) levothyroxine 50 mcg daily insulin nph 100u qam and 100u qpm humalog sliding scale vitamin d advair diskus 250/50 1 puff spiriva trazadone 50mg qhs senna colace 100mg prn albuterol prn furosemide loratidine 10mg daily discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*6* 3. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 4. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 8. ranolazine 500 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po bid (2 times a day). 9. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). disp:*15 tablet(s)* refills:*2* 10. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 11. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 12. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 13. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day). 14. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 15. nph insulin human recomb 100 unit/ml cartridge sig: fifty (50) units subcutaneous twice a day: 50 units qam and 50 units qpm . 16. humalog 100 unit/ml cartridge sig: asdir subcutaneous asdir: per home sliding scale. 17. isosorbide mononitrate 120 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 18. loratadine 10 mg tablet sig: one (1) tablet po once a day. 19. hydralazine 10 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*90 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: acute on chronic renal failure acute on chronic systolic congestive heart failure coronary artery disease chronic obstructive pulmonary disease (copd) discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure being involved in your care, mr. . you came to the hospital with chest pain and difficulty breathing, underwent cardiac catheterization, where you received a stent to one of the small blood vessels that supplies your heart. you came to the ccu (cardiac intensive care unit) because of difficulty breathing after the procedure, which required bipap. your course was also complicated by renal failure which could have been caused by the contrast load needed for catheterization on top of your underlying kidney dysfunction. your medications have changed as follows: 1. increased your aspirin from 81mg to 325mg daily 2. added plavix 75mg daily. it is very important to take this medication every day. do not miss of this medication as it is crucial to keep your stent working- to supply blood flow to your heart. 3. we discontinued your diovan (valsartan 320mg daily) because of your renal function. please do not restart this unless it is safe to do so per your outpatient kidney doctor. 4. we ask you restart your lasix 120mg daily on monday . per the kidney doctors, take this once per day. (you used to take it twice daily). 5. we decreased your allopurinol from 200mg daily to 100mg every other day due to your kidney function 6. changed imdur 90mg twice per day--> to 120mg daily 7. added hydralazine 10mg three times per day 8. added ranitidine 150mg daily for your stomach upset/acid ** please call your kidney doctor to make an appointment for early next week weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: primary care: , m. phone: date/time: thursday at 1:00pm. . nephrology: please call your outpatient nephrologist dr. and make an appointment to see him within one week . cardiology: , d. phone: date/time: at 12;30pm. dr office number is so you can call and make an appointment regarding your pacer. md, procedure: venous catheterization, not elsewhere classified coronary arteriography using two catheters left heart cardiac catheterization insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia acute respiratory failure morbid obesity cardiac pacemaker in situ acute on chronic systolic heart failure diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled postsurgical hypothyroidism 

Answer: The patient is high likely exposed to