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: shellfish derived attending: chief complaint: chest pain, nstemi major surgical or invasive procedure: cardiac catheterization with balloon angioplasty of the perforated right proximal inferior epigastric artery history of present illness: ms. is a 68 yo woman with h/o htn, asthma, gerd, left breast ca, subdural hematoma s/p evacuation with residual difficulty with short term memory, transferred from hospital after being admitted on for chest pain. much of the hpi is given by the patient's daughter, . the patient initially had epigastic pain radiating to her back the night prior to presentation to osh, which resolved with her home omeprazole; the following morning, she presented to the osh complaining of similar pain along with non-exertional chest pain with radiation to left shoulder and back and associated with sob and nausea; tng gtt was started and her pain improved to . initially, the chest pain was not thought to be cardiac in nature as it was reproducible with palpation. however, the morning day prior to transfer, the patient had sudden onset of chest pain, which did not respond to nexium, pepcid and nitro paste; at that time, her biomarkers bumped up once again (troponin peak 5.3, trended down to 1.34 then bumped again to 1.45 am of transfer, ck peaked at 225 and continued to trend down) and she received plavix 300 mg and was started on a heparin and integrilin gtt due to continued chest pain. she was transferred to for cardiac catheterization having continued chest pain, which resolved upon arrival without intervention. the patient has a history of dvt/pe in after initiation of tamoxifen therapy for her breast cancer. on review of systems, she denies any prior history of stroke, tia, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. cardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cad risk factors: hypertension 2. cardiac history: previous cardiac cath in with clean coronaries 3. other past medical history: subdural hematoma (, s/p surgical evacuation, residual short term memory loss) left breast ca s/p lumpectomy, xrt, chemo 7 yrs ago; right portacath in place asthma urinary incontinence depression gerd arthritis obesity social history: widowed and retired, lives with daughter who is a nurse () since subdural hematoma 2 years ago. able to ambulate independently for short distances. -tobacco history: distant history, quit 40 yrs ago -etoh: denies -illicit drugs: denies family history: father with dm, mother with "enlarged heart." physical exam: on admission: general: obese elderly woman in nad. oriented x3; has difficulty recalling past symptoms/events but oriented to person, place and time. mood, affect appropriate. vs: t= 97.7, bp=112/68, hr=70, rr=20, o2 sat= 98% on ra heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple neck, difficult to assess jvp due to body habitus. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no murmurs, rubs or gallops. no thrills, lifts. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, minimal tenderness at ruq. unable to assess abd aorta due to body habitus. extremities: no clubbing, cyanosis or edema. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 1+ radial 2+ dp 1+ pt 1+ left: carotid 1+ radial 2+ dp 1+ pt 1+ on discharge: telemetry: sr 60s, no ectopy. wt. 143.0 kg vs: tm 99.2 tc 98.1 hr 65 (65-74) bp 91/47 (90-123/47-67) rr 20 sao2 96% on ra i/o: , bm x 1 (guaiac pos) general: obese elderly woman in nad. oriented x3; has difficulty recalling past symptoms/events but oriented to person, place and time. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple neck, difficult to assess jvp due to body habitus. cardiac: rr, normal s1, s2. no murmurs, rubs or gallops. no thrills, lifts. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, minimal epigastric tenderness. unable to assess abd aorta due to body habitus. extremities: no clubbing, cyanosis or edema. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 1+ radial 2+ dp 1+ pt 1+ left: carotid 1+ radial 2+ dp 1+ pt 1+ pertinent results: 12.3 6.2 >---< 193 36.4 pt: 12.4 ptt: 31.2 inr: 1.0 14 agap=10 --------------<110 4.8 28 0.7 - ck: 47 mb: 2 trop-t: 0.45 ck: 47 mb: 2 trop-t: 0.44 ca: 9.3 mg: 1.8 p: 2.4 alt: 14 ap: 74 tbili: 0.8 alb: 3.8 ast: 26 ldh: 206 : 36 lip: 28 wbc rbc hgb hct mcv mch mchc rdw plt ct 06:16 5.0 3.12* 10.0* 29.1* 93 32.0 34.4 14.4 198 05:45 4.7 3.15* 9.8* 28.8* 91 31.1 34.0 14.1 217 glucose urean creat na k cl hco3 angap 06:16 119 19 0.6 141 4.1 106 29 10 05:45 110 16 0.6 142 3.9 109* 29 8 alt ast ld(ldh) ck(cpk) alkphos amylase totbili lipase 06:39 10 17 180 21 63 29 1.0 24 ck-mb ctropnt 15:39 2 <0.01 21:42 1 <0.01 07:21 1 <0.01 06:39 1 <0.01 calcium phos mg 05:45 8.7 3.5 1.9 cholest triglyc hdl chol/hd ldlcalc 07:15 154 851 50 3.1 87 9:15 pm blood culture source: peripheral - negative 6:36 pm blood culture source: line-port-a-cath. blood culture, routine (final ): staphylococcus, coagulase negative. isolated from one set only. sensitivities performed on request. of two colonial morphologies. anaerobic bottle gram stain (final ): gram positive cocci in clusters. reported by phone to # at 1330. aerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. mrsa screen (final ): no mrsa isolated. ecg 9:04:34 pm sinus rhythm. premature ventricular complex. poor r wave progression is probably a normal variant. low qrs voltage in the limb leads. no previous tracing available for comparison. cxr : no previous images. the right chest port extends to the lower portion of the svc, though the precise tip is difficult to visualize. no evidence of acute pneumonia or congestion. there is some increased opacification obscuring the right heart border suggesting volume loss in the middle lobe. of incidental note are surgical clips in the left axillary region. cardiac catheterization : 1. selective coronary angiography of this right dominant system demonstrated single vessel coronary artery disease. the lmca was normal in appearence. the lad was normal with a dual lad system. the d2 had a long serpentine 99% lesion in the distal vessel. the lcx and rca were both normal. 2. resting hemodynamics revealed mildly elevated right ventricular filling pressures, with an rvedp of 15 mmhg. the lvedp was not measured. the pa pressures were mildly elevated, with a pa systolic pressure of 40 mmhg. the mean pcwp was mildly elevated at 13mmhg. the central aortic pressure showed no evidence of systmeic hypertension. 3. successful pta of the perforated right proximal inferior epigastric artery with an apex rx 2.5x20 mm to balloon tamponade the arterial bleeding. final angiography revealed normal flow and no further arterial bleeding from the right proximal inferior epigastric artery.(see pta comments) 5. r 6fr femoral artery angioseal closure device deployed without complicatons. 6. r 6fr femoral vein and r 4fr femoral artery sheaths removed with manual compression in cath lab without complications. echocardiogram : the left atrium is normal in size. the estimated right atrial pressure is 0-10mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. the right ventricular cavity is mildly dilated with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal global and regional biventricular systolic function. no pathologic valvular abnormality seen ct abdomen 1. redemonstration of right pelvic extraperitoneal hematoma, stable to minimally increased in size compared to prior study earlier the same day. no active extravasation is identified. the right inferior epigastric is normally opacified at its origin and distally. a focal segment of non-opacification may represent narrowing versus occlusion. evaluation is limited by body habitus. 2. bilateral parapelvic cysts. 3. calcified splenic artery aneurysm. 4. degenerative change in the lumbar spine. 5. calcified uterine fibroid. cta chest : there is no evidence of pulmonary embolism. the pulmonary artery is normal in size and there are no features of right heart strain. a right anterior chest wall density likely represents a portacath disk. surgical clips in the left axilla are consistent with the given history of left-sided breast carcinoma and resection. there is no pathologic enlargement of the supraclavicular, axillary, or mediastinal lymph nodes. the left atrium is mildly enlarged. there is no pericardial or pleural effusion. the airways are patent to the subsegmental level. innumerable 0.5-1 cm noncalcified pulmonary nodules are scattered throughout the lungs, particularly in the lung bases consistent with multifocal metastases. a central venous catheter is present with its distal tip in the lower right atrium. the aorta is normal in caliber, aortic annulus calcification is mild. there is no evidence of aortic dissection. mid thoracic multilevel degenerative disease is moderately severe. the study is not tailored for subdiaphragmatic evaluation, only to confirm prominence of the left renal collecting system, possibly due to parapelvic cysts or an extrarenal pelvis, stable since , a calcified 17 x 20 mm splenic artery aneurysm, a moderately large sliding hiatus hernia, normal-appearing adrenals and exuberant upper lumbar spine osteophytosis. impression: 1. no evidence of pulmonary embolism or aortic dissection. 2. innumerable 0.5-1 cm pulmonary nodules, highly suspicious for metastases, alternative, less likely, diagnoses include septic emboli or multifocal fungal infection. 3. the tip of the central venous catheter is in the lower right atrium. brief hospital course: 68 yo woman with a history of htn, asthma, gerd and left breast ca who presents from osh for cardiac catheterization after developing chest pain at rest with biomarker evidence of nstemi. cardiac catheterization showed diagonal disease, but was complicated by infereior epigastric artery bleeding requiring balloon tamponade; no coronary intervention performed. # cad: patient presented with worsening cp concerning for unstable angina and positive biomarkers, consistent with nstemi. troponin peaked at 5.3 at osh, trended down to 1.34 then bumped again to 1.45 the morning of transfer, ck peaked at 225 and continued to trend down. patient was transferred after being given plavix 300 mg, started on heparin gtt and integrilin gtt due to ongoing chest pain. cardiac catheterization revealed branch diagonal disease, but no coronary intervention due inferior epigastric artery bleeding complication. diagonal leson was also serpentine and not favorable for stenting. biomarkers continued to trend down during admission. patient had repeat episodes of chest pain at rest s/p cardiac catheterization which would be relieved by slng/nitro gtt, morphine, toradol and maalox. of note, chest pain appeared to be musculoskeletal in nature at times, reproducible with palpation, as noted at osh. chest pain also appeared to be gastrointestinal in nature, resolving with maalox and bms. patient now cp free for greater than 48 hrs with isordil 10 mg tid (changed to isosorbide mononitrate at discharge), amlodipine 2.5 mg daily, tylenol 650mg rtc. the patient was started as well on asa 325 mg daily, metoprolol 25 mg daily, plavix 75 mg daily, atorvastatin 80 mg daily, lisinopril 2.5 mg daily; we will discharge the patient to rehabilitation facility on this regimen for medical therapy post-mi. # pump: lvef>55% on echocardiogram, no wall motion abnormalities noted. continued metoprolol, started lisinopril. # rhythm: no known arrhythmias, monitored on telemetry without incident. # htn: bp 91/47 this am. patient remained hemodynamically stable throughout admission, no evidence of ongoing bleed hemodynamically s/p catheterization. continued metoprolol, started lisinopril. # gerd: continued home omeprazole. # asthma: continued albuterol prn # depression: continued home celexa and trazodone # urinary incontinence/hematuria: vesicare not on formulary, tolterodine 1 mg given during admission. will restart patient on vesicare on discharge. initially noted to have hematuria, no evidence of hematuria on discharge. # hx of breast cancer: continued femara 2.5mg daily. innumerable 0.5-1 cm pulmonary nodules, highly suspicious for metastases, alternative, less likely, diagnoses include septic emboli or multifocal fungal infection. blood cultures drawn from portacath were positive for coag negative staph, consistent with contamination. patient will need close follow-up with her pcp upon discharge from rehab to go over ct findings. medications on admission: singulair 10 mg daily (has not taken recently) trazodone 25 mg qhs metoprolol 25 mg daily celexa 40 mg qhs omeprazole 20 mg qhs femera 2.5 mg daily vesicare 10 mg daily discharge medications: 1. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime). 2. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 3. celexa 40 mg tablet sig: one (1) tablet po once a day. 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. letrozole 2.5 mg tablet sig: one (1) tablet po daily () as needed for breast ca. 6. vesicare 10 mg tablet sig: one (1) tablet po once a day. 7. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 8. aspirin 325 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 10. plavix 75 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 11. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 14. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day) as needed for yeast infection. 15. maalox maximum strength 400-400-40 mg/5 ml suspension sig: five (5) ml po prn (as needed) as needed for indigestion. 16. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain: please give up to max of 3 tablets, wait 5 minutes between doses. 17. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily) as needed for constipation. 18. acetaminophen 650 mg tablet sig: one (1) tablet po every six (6) hours. 19. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day) as needed for dry nostrils. 20. amlodipine 2.5 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: house nursing & rehabilitation center - discharge diagnosis: coronary artery disease non-st segment myocardial infarction perforation of the right inferior epigastric artery post-infarct chest pain with some musculoskeletal contribution hypertension prior left breast cancer with pulmonary nodules asthma urinary incontinence depression gastroesophageal reflux disease positive blood culture likely due to contaminant arthritis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the cardiology service because you were found to have a heart attack. you underwent cardiac catheterization without intervention. your cardiac catheterization was complicated by bleeding; the bleeding in your abdomen was noted to be stable by imaging. you continued to have chest pain, and we treated this symptomatically with medication. you were chest pain free for over 36 hours prior to discharge. please make the following changes to your medication: -start imdur 30mg daily -start lisinopril 2.5mg daily -start atorvastatin 80mg daily -start amlodipine 2.5mg daily -start aspirin 325mg daily *** -start plavix 75mg daily *** **please continue aspirin and plavix indefinitely; do not discontinue unless directed by a cardiologist. please continue all other medications as prescribed. followup instructions: name: dr. appointment: monday, time: 3:15pm address: ., , ma phone: md, msc 12-339 procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries procedure on single vessel diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension asthma, unspecified type, unspecified other chronic pulmonary heart diseases personal history of malignant neoplasm of breast depressive disorder, not elsewhere classified accidental puncture or laceration during a procedure, not elsewhere classified cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure personal history of venous thrombosis and embolism obesity, unspecified accidents occurring in residential institution precipitous drop in hematocrit urinary incontinence, unspecified hemorrhage, unspecified arthropathy, unspecified, site unspecified dissection of other artery 

Answer: The patient is high likely exposed to