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: penicillamine / penicillins / egg / chicken derived attending: chief complaint: stemi major surgical or invasive procedure: cardiac catheterization with bare metal stent x2 to the right coronary artery history of present illness: f with diabetes mellitus, htn, hld, niddm, cerebral aneyrysm s/p clipping and carotid artery shunt 40 years ago presents to cath lab with stemi. . this morning after leaving the shower, she developed a severe headache described as occurring suddenly. her family checked her sugar which was fine and took a blood pressure, which was very high to sbp 260. the patient's daughter was concerned because the pt did not feel like going out this morning due to fatigue and headache and she typically is quite active. 911 was called and the patient was brought to . on arrival to the ed she developed chest pressure with radiation straight to the back, and was found to have st segment elevations in inferior, anterior, and lateral leads. the patient was bolused with heparin given high dose aspirin, and received 600 mg plavix. the pt was started on a nitro drip. a non con head ct was performed which demonstrated no acute bleed. she was transferred to the cath lab. . in the cath lab, pt was found to be right dominant, with 90% proximal calcific focal lesion followed by diffusely disease mild to moderate calcific segment, then distal 80% calcific focal lesion. the pt had stenting of proximal and distal rca with deployment of 2 non-overlapping integrity bms and had angioseal applied to rcfa. she received 115 cc of omnipaque contrast. . on the floor, she states feeling well. she denies chest pain currently, shortness of , recent symptoms of orthopnea, pnd, chest pain other than this morning. her daughter does note that she has ankle swelling at baseline. her exercise capacity is approximately walking one block that is limited to fatigue and knee pain. she is active with wheelchair and walker. . on review of systems, she 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. 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, palpitations, syncope or presyncope. past medical history: - dmii - htn - hl - hypothyroidism - osteoarthiris - diverticulosis - s/p hysterectomy - s/p small bowel obstructions - h/o colon cancer s/p resection of tumor - s/p appendectomy - s/p uterine suspension - brain aneurysm s/p clipping social history: - tobacco history: up to 12 years ago. 1ppw for at least 60 years - etoh: denies - illicit drugs: denies family history: - no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; significant family history for stroke. physical exam: admission: general: 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 of 14 cm with prominent v waves. no meningeal signs. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. 2/6 systolic murmur best appreciated at llsb, difficult to detect respiratory variation. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi on anterior and lateral exam. unable to sit pt to listen to back. abdomen: soft, nt. mildly distended with presence of ventral hernia no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. groin: ecchymotic with firmness below groin, likely hematoma. mild oozing. no bruit, good pulse. extremities: 1+ edema up to knees bilaterally. 2+ pulses dp/pt bilaterally. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: aaox3, cnii-xii intact, 5/5 strength biceps, triceps, wrist. no evidence of focal neurological deficits. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ discharge: general: yo f in no acute distress, sitting in bed eating breakfst. heent: mucous membs moist, no lad chest: faint crackles bilat cv: rrr, 2/6 systolic murmur best appreciated at llsb abd: soft, non-tender, non-distended, bs normoactive. no rebound/guarding. ext: wwp, bilat ankle edema. right groin with soft ecchymosis that has increased from yesterday, stable hematoma, no tenderness. neuro: 4/5 strength in u/l extremities. skin: no rash psych: a/o, pleasant and conversant pertinent results: admission: 04:34am blood wbc-7.3 rbc-3.49* hgb-9.9* hct-32.6* mcv-94 mch-28.3 mchc-30.3* rdw-13.1 plt ct-220 01:25pm blood glucose-173* urean-29* creat-1.1 na-132* k-4.8 cl-101 hco3-24 angap-12 04:34am blood calcium-9.0 phos-3.0 mg-2.0 discharge: 06:40am blood wbc-6.7 rbc-3.41* hgb-9.9* hct-31.3* mcv-92 mch-29.1 mchc-31.7 rdw-13.2 plt ct-188 06:40am blood glucose-139* urean-40* creat-1.2* na-136 k-4.5 cl-98 hco3-31 angap-12 06:40am blood calcium-9.1 phos-3.5 mg-2.2 cardiac enzymes: 01:25pm blood ck-mb-3 ctropnt-0.02* ck(cpk)-43 07:00pm blood ck-mb-5 ctropnt-0.12* ck(cpk)-44 04:34am blood ck-mb-7 ctropnt-0.23* ck(cpk)-91 12:51pm blood ck-mb-5 ctropnt-0.20* ck(cpk)-86 cardiac cath , f 94 cardiovascular report cardiac cath study date of *** not signed out *** brief history: year-old female with past medical history of hypertension who presented to with chest pain and was transferred to after ekg showed stemi. indications for catheterization: stemi procedure: coronary angiography via right femoral artery. percutaneous coronary revascularization was performed using placement of bare-metal stent(s). conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. hemodynamics results body surface area: m2 hemoglobin: gms % fick **pressures aorta {s/d/m} 185/73/102 **ptca results rca ptca comments: initial angiography revealed a diffusely diseased proximal rca with a relatively focal 90% calcific stenosis and a distal 80% focal calcific lesion. we planned to treat both with ptca and stenting. a 6f sheath was already in place. heparin was administered for anticoagulation, and therapeutic acts were confirmed throughout the case. a 6f jr4 guide provided adequate support. prowater wire crossed both lesions with little difficulty. the proximal stenosis was dilated with a 2.5 x 12 mm apex balloon at 10 atm. the distal stenosis was dilated with the same balloon at 11 atm. the proximal lesion was again dilated with the same balloon at 13 atm. the distal lesion was stented with a 2.75 x 15 mm integrity delivered at 8 atm. the proximal lesion was stented with a 3.0 x 22 mm integrity delivered at 10 atm. final angiography revealed no residual stenosis, no evidence of dissection and timi 3 flow. right femoral angiography revealed an arteriotomy site appropriate for closure, and a 6f angioseal was deployed with adequate hemostasis. technical factors: total time (lidocaine to test complete) = minutes. arterial time = contrast injected: non-ionic low osmolar (isovue, optiray...), vol ml anesthesia: 1% lidocaine subq. cardiac cath supplies used: - , prowater 300cm 2.5mm , apex 12/1.5 flex 6fr cordis, jr 4 sh 6fr , angioseal vip 2.75mm , integrity 12/2.25 3.0mm , integrity 22/2.25 - allegiance, custom sterile pack - merit, left heart kit - , priority pack 20/30 comments: 1. selective coronary angiography of this right dominant system demonstrated single vessel coronary artery disease. the lmca was patent. the lad had mild luminal irregularities and gives three large diagonal branches, d2 being the largest. the lcx had mild luminal irregularities and gives three large obtuse marginal branches. the rca had a proximal 90% proximal calcific relatively focal lesion followed by diffusely disease, mild-to-moderate calcific segment, then distal 80% calcific focal stenosis. 2. limited resting hemodynamics revealed severe systemic arterial hypertension. 3. successful ptca and stenting of the distal rca with a 2.75 x 14 mm integrity bms (see ptca comments). 4. successful ptca and stenting of the proximal rca with a 3.0 x 22 mm integrity bms (see ptca comments). 5. successful rfa angioseal (see ptca comments). final diagnosis: 1. one-vessel coronary artery disease. 2. successful pci of the distal rca with a 2.75 x 14 mm integrity bms. 3. successful pci of the proximal rca with a 3.0 x 22 mm integrity bms. 4. successful rfa angioseal. tte () poor image quality. the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is probably normal (lvef>50%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are probably normal. the aortic valve leaflets (3) are mildly thickened. the study is inadequate to exclude significant aortic valve stenosis (may have minimal as versus aortic sclerosis). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a prominent fat pad. brief hospital course: yo female with pmhx diabetes mellitus, htn, hld, niddm, cerebral aneyrysm s/p clipping and carotid artery shunt 40 years ago presents to cath lab with ecg changes concerning for inferoanterolateral stemi in setting of hypertensive urgency. . # aborted stemi: the patient was taken to the cath lab and have two stents placed in the rca. her cardiac enzymes were monitored with a peak ckmb of 7. it was felt that the intervention was able to abort significant ischemia given the lack of rise of the ckmb. she tolerated the procedure well, but was noted to have a ecchymosis at the cath site. the site was tender to palpation, but no hematoma or bruit was appreciated. the ecchymosis continued to slow increase but was not felt to be secondary to a fistula or psuedoaneurysm. her hematocrit was closely monitored and remained stable. she did not have additional cp or sob. she is to remain on aspirin and plavix until otherwise directed by her cardiologist (dr. . she was also placed on (was taking pta), a high dose statin, and a betablocker for optimal medical management of her cad. . # acute on chronic diastolic chf: the patient has known diastolic chf and was noted to have crackles and le edema on exam, although she felt it was stable. she was able to comfortably breathe and sat well on ra at rest and with ambulation. her post-mi echo was significant for a preserved lvef (> 50%) and although no focal wall motion abnormalities were noted, it was felt to be a poor image quality study. . # hypertension: she was continued on her home dose of valsartan, with good bp control. she was not continued on her home dose of hctz given her kidney function. she is also not to continue this medication at discharge and the need for this medication going forward should be addressed at her follow up appointment with her cardiologist (dr. . . # hld: given her acs, she was transitioned from her home dose of simvastatin to atorvastatin 80 mg daily. . # dm ii: she was maintained on an insulin sliding scale was out significant episodes of hyperglycemia (average fs 140-170s). she is to be d/c on her home dose of glyburide. . # cri: her gfr was 47 and felt to most likely be her diabetes and htn. her medications were renally dosed and this should continued to be monitored as an outpatient. . # exercise induced asthma: she did not have respiratory distress during her stay and no wheezes were noted. she was continued on her home flovent. . =================================== transitions of care =================================== -please note medication changes -please continue to monitor renal function -please assess bp control and need for hctz. medications on admission: multivitamin 1 tab daily valsartan 80 mg glyburide 2.5 mg daily hctz 25 mg daily simvastatin 40 mg qhs levothyroxine 0.075 mg daily metoprolol succinate xl 25 mg daily fluticasone 110 mcg 2 puffs acetaminophen tramadol 50 mg qid discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/headache. 4. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 5. toprol xl 25 mg tablet extended release 24 hr sig: 0.5 tablet extended release 24 hr po once a day. 6. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po daily (daily): total 7 days, started , stop . 7. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 8. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 9. valsartan 80 mg tablet sig: one (1) tablet po bid (2 times a day). 10. multi-day tablet sig: one (1) tablet po once a day. 11. glyburide 2.5 mg tablet sig: one (1) tablet po once a day. 12. levothyroxine 75 mcg capsule sig: one (1) capsule po once a day. discharge disposition: extended care facility: bay skilled nursing & rehabilitation center - discharge diagnosis: aborted stemi coronary artery disease diabetes type 2 hypertension dyslipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you had chest pain and were having symptoms of a heart attack. you were taken directly to the cardiac catheterization lab at where a blockage was found in your right heart artery. this blockage was cleared and two bare metal stents were placed to keep the artery open. you will need to take aspirin and plavix every day for at least one month and preferably 3 months. do not stop taking aspirin and plavix or miss unless dr. tells you it is ok. your echocardiogram showed that there was minimal damage to your heart muscle. your right groin has some bruising that will go away slowly. call the heartline if you notice any bleeding, increasing pain or swelling. . we made the following changes to your medicines: stop your hydrochlorithiazide stop your simvastatin decrease your toprol to 12.5mg daily start aspirin 325mg daily -because you had a stent placed in your heart start plavix 75mg daily -for the stent in your heart start bactrim ds 1 pill daily for total of 7 days (start ) -for urine infection start atorvastatin 80mg daily -for your cholesterol (stronger than the simvastatin) you will need to have blood work on friday to check your electrolytes and kidney function, these results can be forwarded to dr. . followup instructions: dr. () you have an appointment with (dr. pa) 11am md, procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism acute on chronic diastolic heart failure asthma, unspecified type, unspecified 

Answer: The patient is high likely exposed to