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: precedex attending: chief complaint: chronic mesenteric ischemia major surgical or invasive procedure: mesenteric angio r heart cath open antegrade superior mesenteric artery bypass with graft history of present illness: 66m with pvd and left fem to pt bypass with rgsv four months ago for claudication who presented to an outside hospital several days ago with one month of intermittent abdominal pain and 100 pound weight loss over the past three years and 20 pounds over the last month. imaging was concerning for celiac and sma stenosis with infra-renal aortic aneurysm and bilateral renal artery infarcts. catheterization was attempted but aborted given sma occlusion. given multiple comorbid conditions and the complexity of his disease, he was transferred to for further management. at he reports chronic abdominal pain which is rather diffuse. he states that it has been worse over the past week, is exacerbated by eating and is associated with diarrhea. he reports that his claudication resolved after his lower extremity bypass. past medical history: cad w severe mi ten years ago, chf, grave's disease treated with ptu, sbo, history of now resolved, copd, afib (hx of coum), parastomal hernia, renal infarct, sma stenosis, active smoker (75 pack yr; cut down to 4-5/day), cirrhosis, pulm htn, right heart strain, ischemic left leg social history: 100 pack year smoking history. heavy history of etoh with over 24 beverages consumed daily but has not had an alcoholic beverage in several years family history: sister with lung cancer at 37 yeras of age and another sister with stomach cancer in 70's. brother with cad. physical exam: at time of admission: vital signs: 98.1 80 133/85 20 98 ra general: awake, alert, nad heent: ncat, eomi, anicteric heart: rrr, nmrg lungs: wheezes bilaterally abdomen: soft, mildly tender to palpation in epigastrium extremities: right foot is warm, left foot is slightly cooler. well-healed bypass incision along lle. cap refill < 2 seconds. pulse exam (p=palpation, d=dopplerable, n=none) rle femoral: p. popiteal: p. dp: n. pt: d. lle femoral: p. popiteal: n. dp: n. pt: d. pertinent results: pfts: spirometry 8:37 am pre drug post drug actual pred %pred actual %pred %chg fvc 2.27 4.18 54 fev1 1.74 2.88 61 mmf 1.66 2.74 61 fev1/fvc 77 69 111 lung volumes 8:37 am pre drug post drug actual pred %pred actual %pred tlc 4.74 6.52 73 frc 3.84 3.68 104 rv 2.51 2.34 107 vc 2.25 4.18 54 ic 0.90 2.83 32 erv 1.33 1.34 99 rv/tlc 53 36 148 he mix time 2.50 dlco 8:37 am actual pred %pred dsb 11.35 25.24 45 va(sb) 4.49 6.52 69 hb 14.00 dsb(hb) 11.55 25.24 46 dl/va 2.57 3.87 66 notes: dx: sob, pre-operatory assessment medication: unidentified inhaler not taken prior to testing bmi: 21 hgb: 14.0 () good test quality and reproducibility for spirometry and lung volumes. fvc may be underestimated due to early termination of exhalation in all efforts. effort reported is a composite. svc is likely underestimated due to early termination of exhalation in all efforts. good/fair test quality with poor reproducibility for diffusion capacity. only one effort reported due to unreportable test quality in all other efforts. mechanics: the fvc and fev1 are moderately reduced. the fev1/fvc ratio is elevated. flow-volume loop: moderate restrictive pattern with an abrupt and early termination of exhalation. lung volumes: the tlc is mildly reduced. the frc and rv are normal. the rv/tlc ratio is elevated. dlco: the diffusing capacity corrected for hemoglobin is moderately reduced. impression: mild restrictive ventilatory defect with a moderate gas exchange defect. the fvc is likely underestimated due to an early termination of exhalation and for this reason a coexisting obstructive component cannot be excluded. there are no prior studies available for comparison. right heart cath : hemodynamics results body surface area: 1.73 m2 hemoglobin: 14 gms % fick 100% fio2 nitric oxide **pressures right atrium {a/v/m} */ right ventricle {s/ed} 48/12 pulmonary artery {s/d/m} 48/24/34 47/20/34 42/19/30 pulmonary wedge {a/v/m} */18/14 */30/24 */17/15 **cardiac output card. op/ind fick {l/mn/m2} 2.08 2.43 2.31 **resistances pulmonary vasc. resistance 444 301 fick 100% fio2 nitric oxide **% saturation data (nl) svc low 63 pa main 64 76 75 ao 96 99 100 **arterial blood gas inspired o2 concentr'n 100 100 po2 49 47 other hemodynamic data: the oxygen consumption was assumed. technical factors: total time (lidocaine to test complete) = 2 hours 18 minutes. arterial time = fluoro time = 36 minutes. effective equivalent dose index (mgy) = 208 mgy. contrast injected: none premedications: midazolam 0.5 mg iv fentanyl 25 mcg iv anesthesia: 1% lidocaine subq. cardiac cath supplies used: - , magic torque 180cm - allegiance, custom sterile pack - merit, right heart kit 4fr terumo, glidesheath 7fr , pulmonary wedge pressure catheter 5fr arrow, balloon wedge pressure catheter 110cm comments: 1. resting hemodynamics had marked variation due to atrial fibrillation and respiration. resting measurements revealed a maximal pasp 58 mmhg with an average of 48 mmhg, a mean pa pressure of 34 mmhg, and a mean pcwp of 14 mmhg. 2. measurements on 100% fio2 were obtained after over 50 minutes due to difficulties with arterial access and ability to record a wedge pressure with the pa catheter. the average pasp was 47 mmhg with a maximal value of 60 mmhg with a mean pa pressure of 34 mmhg. the pcwp was measured to be 24 mmhg but this was most likely a damped pa and not a true wedge pressure given subsequent pcwp after 100% inhaled no. 3. with 100% inhaled no, the pcwp was 15 mm hg. there was a mild improvement in pasp with an average of 42 mmhg, 52 mmhg maximal, and mean pa 30 mmhg. pvr improved from a baseline of 5.55 to 3.76 . final diagnosis: 1. mild to moderate pulmonary arterial hypertension with mild elevation of pcw at baseline (consistent with mild left ventricular diastolic dysfunction) and severely elevated pvr (using assumed oxygen consumption). 2. technically challenging rhc and vasodilator study due to extreme difficulty delivering catheters into the pcw position, requiring >30 minutes of effort and 3 different catheters. 3. no improvement in pa pressure with 100% o2. 4. mild improvement in pa systolic pressure, mean pa pressure and pvr with addition of inhaled nitric oxide 40 ppm to 100% o2. 5. no evidence of right-to-left or left-to-right shunts. 6. additional plans per dr. and dr. . echo: echocardiographic measurements results measurements normal range left atrium - long axis dimension: *4.6 cm <= 4.0 cm left atrium - four chamber length: *6.3 cm <= 5.2 cm left atrium - peak pulm vein s: 0.7 m/s right atrium - four chamber length: *6.7 cm <= 5.0 cm left ventricle - septal wall thickness: *1.2 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: *0.5 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: *6.0 cm <= 5.6 cm left ventricle - systolic dimension: 4.7 cm left ventricle - fractional shortening: *0.22 >= 0.29 left ventricle - ejection fraction: 45% >= 55% left ventricle - stroke volume: 45 ml/beat left ventricle - cardiac output: 3.69 l/min left ventricle - cardiac index: 2.03 >= 2.0 l/min/m2 left ventricle - lateral peak e': 0.09 m/s > 0.08 m/s left ventricle - septal peak e': *0.07 m/s > 0.08 m/s left ventricle - ratio e/e': 13 < 15 aorta - sinus level: 3.1 cm <= 3.6 cm aorta - ascending: *3.6 cm <= 3.4 cm aortic valve - peak velocity: 1.0 m/sec <= 2.0 m/sec aortic valve - lvot vti: 13 aortic valve - lvot diam: 2.1 cm mitral valve - e wave: 1.0 m/sec mitral valve - e wave deceleration time: 151 ms 140-250 ms tr gradient (+ ra = pasp): *40 to 42 mm hg <= 25 mm hg pulmonic valve - peak velocity: 0.9 m/sec <= 1.5 m/sec findings pt intubated on vent. left atrium: mild la enlargement. right atrium/interatrial septum: moderately dilated ra. a catheter or pacing wire is seen in the ra and extending into the rv. left ventricle: mild symmetric lvh. moderately dilated lv cavity. mild regional lv systolic dysfunction. no lv mass/thrombus. no resting lvot gradient. no vsd. right ventricle: mildly dilated rv cavity. borderline normal rv systolic function. aorta: mildly dilated ascending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. no mvp. no ms. mild (1+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. no ts. mild tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: no ps. pericardium: no pericardial effusion. conclusions the left atrium is mildly dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is mild regional left ventricular systolic dysfunction with infero-lateral akinesis. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is mildly dilated with borderline normal free wall function. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. nais: doppler waveform analysis reveals monophasic waveforms at the common femoral, superficial femoral and popliteal arteries bilaterally. the right dp and pt are monophasic. the left dp and pt are absent. the right abi is 0.7, the left abi is 0. pulse volume recordings show dampening in the thigh bilaterally, worse on the left than the right. there is appropriate calf augmentation and only mild additional dampening at the right metatarsal. on the left, there is substantially dampened waveform in the thigh with further dampening at the calf and nearly flat trace at the ankle and a flat trace at the metatarsal. impression: bilateral aortoiliac disease and severe left sfa and tibial disease. 04:52am blood wbc-6.7 rbc-2.83* hgb-8.8* hct-27.9* mcv-99* mch-31.1 mchc-31.5 rdw-16.8* plt ct-370 04:52am blood plt ct-370 04:52am blood pt-17.2* inr(pt)-1.6* 05:04am blood plt ct-334 05:04am blood pt-17.5* ptt-33.1 inr(pt)-1.6* 03:31am blood plt ct-268 03:31am blood pt-19.9* ptt-32.8 inr(pt)-1.9* 05:04am blood glucose-112* urean-57* creat-0.8 na-140 k-4.8 cl-109* hco3-23 angap-13 03:47am blood alt-46* ast-74* ld(ldh)-221 alkphos-174* amylase-52 totbili-2.0* brief hospital course: patient was admitted to the vascular surgery service after being transferred from osh for further managment of mesenteric ischemia on . he was made npo and tpn started as well as a heparin drip given a fib and thrombectomy of recent lle bypass. angiography was perfromed on with evidence for severe celiac and sma disease that was not ammendable to percutaneous intervention. decision was made at that time to persue open bypass. due to the patient's multiple comorbidities a cardiac and pulmonary workup was pursued preoperativley. he was noted to be of high operative risk by cadiology and right heart cath was performed on with results showing severe pulmonary htn. he was medically optimized and on he underwent a single vessel antegrade sma bypass. he failed extubation and was admitted to the cvicu where he had labile pressures requiring multiple pressure support. on he demonstrated post-op transaminitis. on he went into sepsis with respiratory decopensation with hypotension requiring 3 pressors. this was suspected to be from volume overload and severe pulmonary hypertension. a cxr showed a multifocal pna, urine and sputum grew e coli. antibiotic coverage was changed. on he had a cold foot, demonstrating that he had thrombosed a prior bypass graft in his leg despite the fact that he was on sub q heparin prophylaxis. he was restarted on his heparin drip. he continued to improve and on had weaned down to one pressor though he continued to fail spontaneous breathing trials. he developed thrombocytopenia on the 27th and hem-onc was consulted. the recommendations from the consulting team were that his thrombocytopenia was likely secondary to his septic shock and that he ought to continue his heparin drip therapy. he was extubated on the 30th. a speech and wallow consult was retained and they recommended that it was ok for him to take po. on the 31st he was at his baseline mental status and getting out of bed to chair. on he was admitted to the floor, worked with pt and expressed a desire to go home. he tolerated po medication, was normotensive, returned to his baseline activity level, tolerated food and was ready to be discharged. he was discharged on in good/stable condition. medications on admission: coumadin 2 daily, coreg 6.25 daily, lisinopril 2.5 daily, asa 81 daily, vicodin 5/500 prn, ptu 50 daily, lasix 20 prn, symbicort 160/80 , xopenex neb prn, ipratropium neb prn discharge medications: 1. albuterol inhaler 4 puff ih q4h:prn sob 2. artificial tear ointment 1 appl both eyes tid:prn dry eyes 3. aspirin 81 mg po daily 4. carvedilol 3.125 mg po bid hold for hr<60,sbp<90 5. enoxaparin sodium 60 mg sc bid rx *enoxaparin 60 mg/0.6 ml ingect 60 mg twice daily disp #*30 each refills:*0 6. fluticasone-salmeterol diskus (250/50) 1 inh ih 7. furosemide 20 mg po daily 8. ipratropium bromide mdi 6 puff ih qid:prn sob 9. oxycodone (immediate release) 5 mg po q4h:prn pain rx *oxycodone 5 mg tablet(s) by mouth q 4hr disp #*60 tablet refills:*0 10. propylthiouracil 50 mg po q 24h 11. trazodone 25 mg po hs:prn insomnia 12. warfarin 3 mg po daily16 rx *jantoven 1 mg 3 tablet(s) by mouth daily disp #*50 tablet refills:*0 discharge disposition: home with service facility: , discharge diagnosis: chronic mesenteric ischemia ischemia of left lower extremity secondary to failure of previous bypass graft severe pulmonary hyptertension right heart dysfunction respiratory failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: what to expect when you go home: it is normal to feel tired, this will last for 4-6 weeks ?????? you should get up out of bed every day and gradually increase your activity each day ?????? unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs increase your activities as you can tolerate- do not do too much right away! it is normal to have a decreased appetite, your appetite will return with time ?????? you will probably lose your taste for food and lose some weight ?????? eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? no driving until post-op visit and you are no longer taking pain medications ?????? unless you were told not to bear any weight on operative foot: ?????? you should get up every day, get dressed and walk ?????? you should gradually increase your activity ?????? you may up and down stairs, go outside and/or ride in a car ?????? increase your activities as you can tolerate- do not do too much right away! ?????? no heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? you may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed ?????? take all the medications you were taking before surgery, unless otherwise directed ?????? take one full strength (81mg) enteric coated aspirin daily, unless otherwise directed ?????? call and schedule an appointment to be seen in 2 weeks for staple/suture removal call if yur develope discoloration, pain or signs of infection of the left lower leg followup instructions: please follow up with dr. in 2 weeks, please call ( to schedule please follow up with your pcp, . for 10 am appt. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization aortography arteriography of other intra-abdominal arteries pulmonary artery wedge monitoring right heart cardiac catheterization other intra-abdominal vascular shunt or bypass central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: acidosis thrombocytopenia, unspecified anemia, unspecified coronary atherosclerosis of native coronary artery tobacco use disorder urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation other chronic pulmonary heart diseases atrial flutter percutaneous transluminal coronary angioplasty status paroxysmal ventricular tachycardia loss of weight surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation septic shock old myocardial infarction other complications due to other vascular device, implant, and graft long-term (current) use of anticoagulants pneumonia due to escherichia coli [e. coli] septicemia due to escherichia coli [e. coli] acute vascular insufficiency of intestine atherosclerosis of native arteries of the extremities, unspecified chronic vascular insufficiency of intestine arterial embolism and thrombosis of lower extremity colostomy status nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] acute respiratory failure following trauma and surgery acquired absence of intestine (large) (small) celiac artery compression syndrome 

Answer: The patient is high likely exposed to