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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath/ nstemi major surgical or invasive procedure: cardiac catherization on and second cardiac catherization on with 2 bms placed to svg on r-pda. history of present illness: presented to with dyspnea, after he couldn't catch his breath and felt like he needed help. the episode was acute in onset, and was present at rest and exertion. it was associated with diaphoresis. it was not associated with any chest pain,nausea, or other complaints. for the last 6 weeks his sons have noticed more shortness of breath with exertion and less distances walked before he has to stop (approx 50 feet). they are not sure what is causing this but feel like the humid weather is adversely effecting his breathing. he also had a recent admission to on for chf exacerbation in which he was diuresed and discharged after clinically improving. before this 6 week period he was functioning at a higher level and was independently ambulatory with a prosthetic left leg. the patient also has had a chronic nonproductive cough which has been present for the last 6 months, associated with no fevers or chills. he denies any orthopnea, or paroxysmal nocturnal dyspnea, or palpitations. he is usually compliant with his medications but sometimes forgets to take them 1 to 2 times a month. at he was ruled out for pe (on cta which also saw no signs of pneumonia , with bilateral effusion and basilar atelectasis, mediastinal lymphadenopathy), and was felt like to have a copd exacerbation (according to patient he has never been diagnosed with copd,/ was never hypercarbic with abg's on this admission) or pneumonia (no clear evidence of pneumonia on the cta ), with positive troponins. he was started on nebulizers, iv steroids and antibiotics. he was in atrial fibrilliation with possible anterior inferior infarct. he was ruled in for nstemi. he was started on heparin drip, plavix, lipitor, metoprolol 25 , and serial ekg's. third set of troponins increased to 1.14 from .23 initially. he was also given insulin and kayexalate for hyperkalemia during the admission. he was also given lasix and outputed well. positive blood cultures from which showed gram positive cocci in clusters and was started on vancomycin. he remained afebrile. infectious diseases suggested 3 more doses of vancomycin 1 gram after each hemodialysis session for next 3 times. he was never found to be fluid overloaded, except once on physical exam during the admission when he was given a lasix bolus as he still makes urine. . on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . initial vitals at were t-97, bp -132/67, hr 90, o2 sat 94% on 3l nc . . vitals on transfer : t=95.6 bp=115/70 hr=78 rr=20 o2 sat= 98% . the patient on transfer is in no acute distress, and had no pain or complaints. he is feeling better and does not feel short of breath. his 2 sons who were present also agree that he looks much better than a couple of days ago. past medical history: 1. cardiac risk factors: diabetes, hypertension 2. cardiac history: -cabg: s/p cabg in : lima-->d1, svg-->om2, svg-->pda -percutaneous coronary interventions: : 1. selctive coronary angiography of this right dominant coronary circulation demonstrated native 3 vessel disease. the lmca was free of angiographically significant stenosis. there was a 60% stenosis in the proximal lad. the first diagonal branch was totally occluded. the lcx was a small vessel with diffuse disease that gave rise to a very small om1. a much larger om2 was totally occluded. the rca was totally occluded in its mid segment. 2. venous conduit arteriography demonstrated a svg to om2 that was free of angiographically significant disease. a second svg to the r-pda was 90% occluded in its mid segment by thrombus. there was competative flow to the antegrade limb. 3. arterial conduit angiography demonstrated a 60% stenosis in the mid segment of a lima graft to a large d1 at the site of a kink in the vessel. 4. resting hemodynamics revealed severely elevated left and right heart filling pressures (rvedp=30mmhg and lvedp=28mmhg). there was near equalization of diastolic pressures. there was no evidence of ventricular interdependence with simultaneous rv and lv tracings to suggest constrictive disease. a restrictive process is possible. there was no clear evidence of a pulsus paradoxus within the limits imposed by his atrial fibrillation. the cardiac index was preserved (ci=2.1l/min/m2). there was moderate pulmonary arterial systolic and diastolic hypertension (sbp=46mmhg and dbp=33mmhg). systemic arterial pressures were normal.filling pressures elevated, mean rap 32, rv pressures 50-60s/20, pa pressures 46, edfp 28, with mean pressure of 34 but no ventricular interdepence. during the procedure following given:midazolam 1 mg iv, fentanyl 50 mcg iv, asa 325 mg p.o, clopidogrel 75mg . -pacing/icd: none 3. other past medical history: . 1) esrd dm2; peritoneal dialysis catheter placed on 2) cad s/p cabg in : lima-->d1, svg-->om2, svg-->pda 3) congestive heart failure, ef~40-45% 4) type 2 diabetes 6) hypertension 7) anemia 8) eosinophilia 9)peripheral vascular disease social history: lives in with his wife. smoked 2 ppd x 42 years currently still smokes. no etoh. retired but works intermittently driving a dump truck. family history: father had valve replacement, mi. mother died of lung cancer. physical exam: vs: t=95.6 bp=115/70 hr=78 rr=20 o2 sat= 98% 3l nc general: in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp elevated at mandible cardiac: pmi located in 5th intercostal space, midclavicular line. irregular rhythm, no m/r/g. no thrills, lifts. no s3 or s4. no pulsus paradoxus but 10mm hg by doppler. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. crackles in bilateral bases up to the mid lung fields with decreased breath sounds at the lower lobes bilaterally. wheezes auscultated at left upper lobe field. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: no femoral bruits, right femoral entry site is intact with no draining fluid or hematoma. skin: no stasis dermatitis, ulcers on hands bilaterally and on toes on the right foot, xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ . pertinent results: admission labs 09:20pm glucose-136* urea n-63* creat-6.6*# sodium-133 potassium-4.8 chloride-89* total co2-27 anion gap-22* 09:20pm estgfr-using this 09:20pm ck(cpk)-54 09:20pm ck-mb-7 ctropnt-2.02* 09:20pm calcium-7.7* phosphate-9.9*# magnesium-2.2 cholest-107 09:20pm triglycer-188* hdl chol-34 chol/hdl-3.1 ldl(calc)-35 09:20pm tsh-0.65 09:20pm wbc-10.3# rbc-3.52* hgb-11.0* hct-35.0* mcv-100* mch-31.4 mchc-31.5 rdw-17.4* 09:20pm plt count-220 09:20pm pt-13.9* ptt-25.5 inr(pt)-1.2* 05:03pm type-art po2-77* pco2-45 ph-7.40 total co2-29 base xs-1 intubated-not intuba 05:03pm o2 sat-93 . discharge labs 05:18am blood wbc-12.5* rbc-3.80* hgb-11.7* hct-37.7* mcv-99* mch-30.8 mchc-31.1 rdw-17.3* plt ct-204 05:21am blood wbc-10.0 rbc-4.07* hgb-12.9* hct-40.7 mcv-100* mch-31.8 mchc-31.8 rdw-17.6* plt ct-217 05:18am blood plt ct-204 05:18am blood pt-14.1* ptt-32.7 inr(pt)-1.2* 10:31pm blood pt-18.5* ptt-150* inr(pt)-1.7* 05:18am blood glucose-50* urean-69* creat-7.2*# na-135 k-4.5 cl-90* hco3-30 angap-20 10:35pm blood na-132* k-4.2 cl-89* 05:21am blood glucose-108* urean-51* creat-5.7*# na-136 k-4.1 cl-91* hco3-29 angap-20 05:18am blood ck(cpk)-79 10:35pm blood ck(cpk)-83 04:35am blood ck(cpk)-58 04:35am blood ck-mb-7 ctropnt-2.09* 09:20pm blood ck-mb-7 ctropnt-2.02* 05:18am blood calcium-7.5* phos-8.9* mg-2.4 05:21am blood calcium-7.8* phos-7.5*# mg-2.4 04:35am blood calcium-7.6* phos-10.6* mg-2.3 09:20pm blood triglyc-188* hdl-34 chol/hd-3.1 ldlcalc-35 09:20pm blood tsh-0.65 . microbiology: no mrsa isolated , blood cultures no growth to date . reports: . cardiac catherization indications for catheterization: 1. coronary artery disease 2. nstemi 3. congestive heart failure procedure: right heart catheterization: was performed by percutaneous entry of the right femoral vein, using a 7 french pulmonary wedge pressure catheter, advanced to the pcw position through an 8 french introducing sheath. cardiac output was measured by the fick method. left heart catheterization: was performed by percutaneous entry of the right femoral artery, using a 5 french angled pigtail catheter, advanced to the left ventricle through a 5 french introducing sheath. coronary angiography: was performed in multiple projections using a 5 french jl4 and a 5 french jr4 catheter, with manual contrast injections. graft angiography: of 2 saphenous vein bypass grafts was performed using a 5 french right with manual contrast injections. arterial conduit angiography: of a left internal mammary artery graft was performed using a preformed catheter, with manual contrast injections. conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. hemodynamics results body surface area: 2.11 m2 hemoglobin: 11.3 gms % fick **pressures right atrium {a/v/m} /35/31 right ventricle {s/ed} 46/30 pulmonary artery {s/d/m} 46/33/39 pulmonary wedge {a/v/m} /33/33 left ventricle {s/ed} 110/28 aorta {s/d/m} 110/58/76 **cardiac output heart rate {beats/min} 90 rhythm atrial fibrillation o2 cons. ind {ml/min/m2} 120 a-v o2 difference {ml/ltr} 58 card. op/ind fick {l/mn/m2} 4.4/2.1 **resistances systemic vasc. resistance 818 pulmonary vasc. resistance 109 **% saturation data (nl) pa main 52 ao 90 **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca diffusely diseased 2) mid rca discrete 100 3) distal rca normal 4) r-pda normal obtuse marginal-1 4a) r-post-lat normal **arteriography results morphology % stenosis collat. from **left coronary 5) left main normal 6) proximal lad discrete 60 6a) septal-1 normal 7) mid-lad normal 8) distal lad normal 9) diagonal-1 discrete 100 12) proximal cx normal 13) mid cx normal *** 13a) distal cx normal 14) obtuse marginal-1 normal 15) obtuse marginal-2 discrete 100 **arteriography results to segments morphology % stenosis location **bypass graft 28) svbg #1 20 normal 29) svbg #2 4 diffusely diseased 90 mid 32) lima 15 discrete 60 mid technical factors: total time (lidocaine to test complete) = 1 hour 19 minutes. arterial time = 1 hour 3 minutes. fluoro time = 15.3 minutes. irp dose = 1502 mgy. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 80 ml premedications: midazolam 1 mg iv fentanyl 50 mcg iv asa 325 mg p.o. clopidogrel 75mg anesthesia: 1% lidocaine subq. anticoagulation: heparin 0 units iv cardiac cath supplies used: - allegiance, custom sterile pack - merit, left heart kit - merit, right heart kit 7fr , pulmonary wedge pressure catheter comments: 1. selctive coronary angiography of this right dominant coronary circulation demonstrated native 3 vessel disease. the lmca was free of angiographically significant stenosis. there was a 60% stenosis in the proximal lad. the first diagonal branch was totally occluded. the lcx was a small vessel with diffuse disease that gave rise to a very small om1. a much larger om2 was totally occluded. the rca was totally occluded in its mid segment. 2. venous conduit arteriography demonstrated a svg to om2 that was free of angiographically significant disease. a second svg to the r-pda was 90% occluded in its mid segment by thrombus. there was competative flow to the antegrade limb. 3. arterial conduit angiography demonstrated a 60% stenosis in the mid segment of a lima graft to a large d1 at the site of a kink in the vessel. 4. resting hemodynamics revealed severely elevated left and right heart filling pressures (rvedp=30mmhg and lvedp=28mmhg). there was near equalization of diastolic pressures. there was no evidence of ventricular interdependence with simultaneous rv and lv tracings to suggest constrictive disease. a restrictive process is possible. there was no clear evidence of a pulsus paradoxus within the limits imposed by his atrial fibrillation. the cardiac index was preserved (ci=2.1l/min/m2). there was moderate pulmonary arterial systolic and diastolic hypertension (sbp=46mmhg and dbp=33mmhg). systemic arterial pressures were normal. final diagnosis: 1. three vessel coronary artery disease. 2. acute myocaridal infarction with thrombus in the svg -> r-pda graft. the patient became very uncomfortable during the procedure and pci could not be pursued safely. he understood the risks of this and chose to return for pci the following day. the patient should be maintained on plavix and heparin pending repeat catheterization. 3. severely elevated right and left heart filling pressures. this may be explained by volume overload and diastolic dysfunction, but restrictive/constrictive process should be considered. there was no interventricular independence. he should undergo dialysis and an echocardiogram should be obtained. . ekg atrial fibrillation with a rapid ventricular response, new as compared with prior tracing of . there is low limb lead voltage. evidence of prior inferior myocardial infarction. cannot exclude prior anterior wall myocardial infarction. compared to the previous tracing of there is variation in precordial lead placement. however, the lateral st segment depression is more prominent. the q-t interval remains prolonged. clinical correlation is suggested. . echo the left and right atrium are moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated with severe hypokinesis of the interolateral, inferior, and septal walls. the remaining segments contract normally (lvef = 35-40 %). no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size is normal. with moderate global free wall hypokinesis. the aortic root is moderately dilated at the sinus level. the aortic valve leaflets are moderately thickened (?fusion of left and non-coronary leaflets which are relatively immobile). there is minimal aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets and supporting structures are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: left ventricular cavity enlargement with regional systolic dysfunction c/w multivessel cad. minimal aortic valve stenosis. mild mitral regurgitation. pulmonary artery systolic hypertension. dilated thoracic aorta. compared with the report of the prior study (images unavailable for review) of , the left ventricular cavity is now smaller with more extensive regional dysfunction now involving the septum and right ventricular free wall. the other findings are similar. the rhythm now appears to be atrial fibrillation. clinical implications: the patient has mild aortic stenosis. based on acc/aha valvular heart disease guidelines, a follow-up echocardiogram is suggested in years. the left ventricular ejection fraction is <40%, a threshold for which the patient may benefit from a beta blocker and an ace inhibitor or . based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. . cxr indication: recent below knee amputation, coronary artery disease, and bypass grafting, shortness of breath. evaluate for edema. findings: comparison with radiographs dated indicates resolution of the small right pleural effusion and stable moderately severe cardiomegaly on a background of bypass grafting. impression: moderately severe cardiomegaly is stable since . no radiographic evidence of acute pulmonary edema. brief hospital course: 70yo male with multiple medical problems including chronic systolic heart failure with diastolic dysfunction, atrial fibrilliation(age unknown, thought to be in last 2 weeks), triple vessel cabg, esrd ,dm, htn and peripheral vascular disease presenting with worsening dyspnea over the last 6 weeks and with acute episode sob on which required hospitalization at transferred to for nstemi cardiac catherization. . # nstemi- he denied any chest pain but had a prolonged history of sob. ecg showed an old inferior infarct and seemingly new lateral st depression. at they ruled in for nstemi and was started on a heparin drip, plavix, lipitor, and metoprolol and serial ecgs were taken. his troponin increased from 0.23 to to 1.14 and peaked at 2.09 on . echo showed left ventricular cavity enlargement with regional systolic dysfunction c/w multivessel cad and new changes included a smaller left ventricular cavity with more extensive regional dysfunction now involving the septum and right ventricular free wall. cardiac catherization on showed venous conduit arteriography demonstrated a svg to om2 that was free of angiographically significant disease. a second svg to the r-pda was 90% occluded in its mid segment by thrombus. there was competative flow to the anterograde limb. furthermore arterial conduit angiography demonstrated a 60% stenosis in the mid segment of a lima graft to a large d1 at the site of a kink in the vessel. it was felt that his occluded pda should be targeted and at a second caridac catherization () he had 2 bms placed in his second svg to the r-pda. post-procedure, he was initially managed with an iv heparin infusion and this was later changed to s/c for dvt prophylaxis. we continued atorvastatin, aspirin and clopidogrel. lipid panel showed a ldl 35 hdl 34. commenced metoprolol for rate control. . # chronic systolic heart failure with diastolic dysfunction- most probably ischemic in nature given his extensive cad disease. 6 weeks dyspnea prior to admission was felkt likely due to exacerbation of congestive cardiac failure in the context of new af. his most recent cath showed near equalization of diastolic pressures with o obvious signs suggestive of constrictive disease. a restrictive process is still possible, however there was no clear evidence of a pulsus paradoxus within the limits imposed by his atrial fibrillation, and overall it was felt that these findings were consistent with potential constrictive/restrictive pericardial process which could be affecting his heart function. his ef was depressed at 35-40%. there were minimal valvular abnormalities but there was evidence of pulmonary artery systolic hypertension with a dilated thoracic aorta. a cxr on showed moderately severe cardiomegaly but no radiographic evidence of acute pulmonary edema following dialysis. he continued in af and it was not deemed safe to warfarinise due to falls risk and it was felt that cardioversion would likely not be successful if attempted. he was diuresed with good urine output and metoprolol and lisinopril were started . his shortness of breath improved and he was discharged home. . # atrial fibrilliation- the patient's first documentated case is , his ekg before that on showed normal sinus rhythm. possible causes include thyroid disease but his tsh was normal, pe was ruled out with a negative cta at and it was felt that this was likely secondary to his left atrial enlargement. score is 3 points.tsh was normal. he was started on metoprolol for rate control. he qualified for coumadin however due to falls risk and medication compliance issues the decision was made not to start warfarin. cardioversion was considered but it was felt that given his left and right atrial enlargement that the chances of success would be low. his af is rate-controlled with metoprolol. . # esrd- 4 year history, felt likely secondary to hypertension and dm. at , he was was given insulin and kayexalate for hyperkalemia.at teh , we continued his dialysis regimen with a uf goal of 3.5l and this improved his cardiac failure. we continued renagel, sevelamer and ferrous sulfate. . #possible bacteremia- positive blood cultures set from at which showed gram positive cocci in clusters and was started on vancomycin. he remained afebrile with no signs of infections. infectious diseases at needhman suggested 3 more doses of vancomycin 1 gram after each hemodialysis session for next 3 times.after reviewing the records only 1/4 bottles grew gram positive cocci in clusters on .we discontinued vancomycin regimen given the absence of any clinical signs of infection.blood cultures taken on and , have no growth to date. these should be followed up. . #metabolic acidosis- according to our records, the abg's done at and the current labs in house showed a increased anion gap metabolic acidosis with respiratory compensation.possible etiologies include uremia. the patient is currently recieving dialysis three times a week, with the last being on . salicylate toxicity remains unlikely after speaking with the patient.we touched base with renal about dialysis regimen as it seems to have recently been inadequate, renal has been made aware of this and felt like his current regimen is adequate. they do suspect thar he has not been compliant with his medications given his short term memory issues and that this may be intefering with his fluid status. . # type 2 diabetes- adjusted insulin sc with 16 units lantus at pm. . # potential dementia/ depression- has exhibited more short term memory loss according to his family since his wife died 6 months ago. this appears to be a more chronic progressive dementia taht has now been picked up in the context of his wife's death and him not being able to hide his symptoms. during this admission he has exhibited mild confusion at times at night, when he forgets why he is in the hospital but will still remain oriented to time and place in these episodes. continued home dose fluoxetine. lorazepam prn was given for anxiety. mini mental on was 22/30 with significant impairment in short-term memory. . #hypertension held bp meds amlodipine, imdur, clonidine. given systolic blood pressures in 90'-120, bp currently being well controlled with metoprolol and lisinopril. medications on admission: tel to pharmacy home meds confirmed on: metoprolol succinate 150mg qd lisinopril 40mg qd furosemide 20g qd isosorbide mononitrate 60mg qd fluoxetine 40mg qd amlodipine 10mg qd clonidine 100mcg clopidogrel 75mg qd glargine 20u at night' sevelamer simvastatin 40mg qd aspirin 81mg qd discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*1* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation . 4. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 5. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 6. fluoxetine 40 mg capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*2* 7. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 9. simvastatin 40 mg tablet sig: one (1) tablet po at bedtime. 10. metoprolol succinate 100 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po daily (daily). 11. sevelamer hcl 800 mg tablet sig: three (3) tablet po three times a day: to be taken with meals. 12. lantus 100 unit/ml solution sig: sixteen (16) subcutaneous once a day. discharge disposition: home with service facility: discharge diagnosis: primary: non-st elevation mi acute on chronic systolic congestive heart failure secondary: end stage renal disease on hd hypertension hyperlipidemia 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: it was a pleasure to care for you as your doctor. you were brought to the hospital because of shortness of breath which you experienced at home. during your hospitalization you had several tests done which ruled out a lung clot. however you were found to have a clot in one of your cabg vein grafts on your heart. this clot was cleared by cardiac catherization, where two stents were placed in this area. another test also revealed your heart is not pumping as affectively as it should. we feel like your shortness of breath is therefore caused by disease in your heart which is also causing fluid to collect in your lungs. your weight prior to leaving was 190 pounds. it is essential you weigh yourself every morning, call your primary care doctor if your weight goes up more than 3 lbs. so, you should call your doctor if you weigh more than 193 pounds. you should continue the following medications with the following important changes: 1. decrease lantus to 16 units daily as your blood sugars were quite low on your previous 23 units daily. 2. stop: isorsorbide mononitrate as you had no evidence of chest pain after your procedure. 3. stop: amlodipine 4. stop: clonidine 5. stop furosemide 6. continue: sevelmer 2400 mg with meals 7. continue: nephrocaps, 1 capsule daily ****your kidney doctors monitor your blood pressure in dialysis and re-adjust your blood pressure regimen as needed. you did not have high blood pressure in the hospital, so we did not re-start some of your home medications.**** ****it is very important you remain compliant with your medications*** ***it is very important that you keep all of your doctor's apointments.*** followup instructions: cardiology: (you will see dr. soon. you also have an appointment with dr. later in the month) name: , md when: thursday, , 2pm location: cardiology address: , , phone: primary care doctor: department: (your pcp is . , however he has no appointments available at this time. you will see dr. the meantime and follow up with dr. when: friday at 1:45 pm with: , md building: sc clinical ctr campus: east best parking: garage cardiology: provider: . date: at 1pm location: building telephone number: procedure: insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters hemodialysis arteriography of femoral and other lower extremity arteries transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: acidosis end stage renal disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified coronary atherosclerosis of autologous vein bypass graft atrial fibrillation other persistent mental disorders due to conditions classified elsewhere acute on chronic systolic heart failure diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled chronic total occlusion of coronary artery 

Answer: The patient is high likely exposed to