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: zyprexa attending: chief complaint: crescendo chest pain major surgical or invasive procedure: cardiac catheterization subclavian artery stent placement history of present illness: this is an 87m s/p cabg w/ cp that has been intermittent for the last several weeks, however it is increasing in frequency today. in the past it has been increased by quick bouts of exertion (anxiety, changs in position, going outside into the heat) but not gradually increasing exercise at the gym, it is improved with nitro, as is his heartburn. on dr. sent him for a stress mibi which showed a newly decreased ef of 37% and an inferolateral partially reversible perfusion defect new since ' but old from '?. dr arranged for a consultation with dr. to discuss possible cath on monday, however when dr. called the patient told him he had been have cp all day and dr. sent him to the ed. . in the ed, initial vs: 97.0 66 137/88 16 99%, he initially reported 1/10 chest pain. ekg was read as sinus at 73 with hyperacute t's concerning for increase from prior. trop was negative. heparin bolus and drip was started and he was given 1 sl ntg. he was admitted to for planned cath. patient take full strength asa at home. . currently, he is cp free. past medical history: 1. cad s/p cabg in 2. peripheral vascular disease s/p right common femoral artery to posterior tibial bypass graft with non-reverse saphenous vein 3. angina which is stable. 4. diabetes type 2. (dr. - ) 5. progressive hearing loss s/p cochliar implant done in . 6. bilateral carotid disease has had status post ceas in and again in and . 7. status post turp. 8. severe left renal artery stenosis s/p stenting of the left renal artery. (; dr. 9. cri (baseline ~2.0) social history: the patient quit smoking in , has an average of seven drinks a week, has no experience with recreational drugs, or received tattoos. the patient may have had transfusions. he is currently retired and was the president of a company and describes himself as an inventor. family history: positive for diabetes mellitus physical exam: admission exam: vs - temp 98.3 f, 181/96 bp , 50 hr , 18 r , o2-sat 95% ra general - alert, interactive, well-appearing in nad heent - perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, no jvd, no carotid bruits heart - midline scar pmi non-displaced, rrr, nl early peaking faint systolic murmur s1-s2, lungs - ctab, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use abdomen - nabs, soft/nt/nd, no masses or hsm extremities - wwp, no c/c/e, 2+ peripheral pulses skin - no rashes or lesions lymph - no cervical, axillary, or inguinal lad neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, dtrs 2+ and symmetric, cerebellar exam intact, steady gait discharge exam 98.6, 142/66, 57, 18, 98% ra gen: deaf, aox3, nad heart: rrr, flow murmur at lusb, soft systolic murmur at apex, jvd not elevated lungs: ctab abd: soft, ttp in rlq, ecchymosis of left and right groin and abdomen traveling around the flanks ext: warm, no edema pertinent results: admission labs: 06:15pm blood wbc-8.5# rbc-4.72# hgb-14.7# hct-46.1# mcv-98# mch-31.1 mchc-31.9 rdw-13.6 plt ct-214 06:29am blood pt-10.9 ptt-52.6* inr(pt)-1.0 06:15pm blood glucose-236* urean-38* creat-2.4* na-139 k-4.5 cl-103 hco3-25 angap-16 06:29am blood calcium-8.9 phos-3.2 mg-2.2 discharge labs: 06:50am blood wbc-10.6 rbc-3.74* hgb-11.5* hct-36.1* mcv-97 mch-30.8 mchc-31.9 rdw-14.0 plt ct-173 06:50am blood glucose-174* urean-35* creat-2.2* na-133 k-4.3 cl-99 hco3-27 angap-11 06:50am blood calcium-8.6 phos-2.8 mg-2.0 ====================== ekg: sinus rhythm. left axis deviation. left ventricular hypertrophy with st-t wave changes consistent with left ventricular hypertrophy. compared to the previous tracing of the findings are similar. ============== cxr: impression: right base opacity may be due to atelectasis or possible pleural effusion. underlying consolidation cannot be entirely excluded. dedicated pa and lateral views would be helpful for further evaluation if and when patient able. again seen fractured upper two most sternal wires. ============== tte: the left atrium is elongated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets are moderately thickened. mild to moderate (+) aortic regurgitation is seen. moderate (2+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is no pericardial effusion. . impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. pulmonary artery hypertension. mild-moderate aortic regurgitation moderate mitral regurgitation. compared with the report of the prior study (images unavailable for review) of , the severity of aortic regurgitation, mitral regurgitation and estimated pa systolic pressure are all now higher. regional left ventricular systolic function is now normal with improved global systolic function. . clinical implications: 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. ====================== cardiac cath: 1. selective coronary angiography demonstrated native three vessel coronary disease. the lmca had a 30% stenosis. the lad had 100% mid-vessel stenosis. the lcx had a 90% proximal lesion and a 90% lesion in the om branch. the rca was occluded proximally. 2. arterial conduit angiography demonstrated widely patent lad-lima. 3. venous conduit angiography demonstrated a 90% focal stenosis in the jump segment between the om and the diagonal branches. 4. arterial angiography demonstrated 90% ostial subclavian stenosis. 5. limited resting hemodynamics revealed severe systemic systolic arterial hypertension. final diagnosis: 1. three vessel coronary artery disease. 2. severe systemic arterial hypertension at the start of the case. 3. subclavian stenosis ======================== femoral ultrasound: impression: no pseudoaneurysm. no av fistula. no hematoma identified in either groin. ======================== brief hospital course: 87m with h/o cabg in at , dm2, htn, ckd, hyperlipidemia and recent stress-mibi showing an area of reversible ischemia who presents with crescendo chest pain concerning for unstable angina. . 1. unstable angina: the patient had negative cardiac enzymes and an ekg that did not show acute ischemic changes. the patient was started on a heprain gtt, aspirin, but was not plavix loaded. he was continued on his beta blocker, atorvastatin, and nitroglycerin. the patient did not have any chest pain prior to his cardaic catheterization. he underwent a cath on with findings of 30% lmca, 100% mid-lad, 90% prox-lcx, 90% om, and total occlusion rca. a patent lima-lad, and 90% stenosis in the svg jump segment between om and diagonal. a pci to om with des was deployed. the procedure was complicated by trouble deploying the femoral sheath, hematoma and hypotension, requiring 4 units prbcs. a fem stop was held overnight and bilateral ultrasounds showed no hematoma or pseudoaneurysm identified. the patient also was found to have subclavian artery stenosis, which was thought to be flow limiting to the lima to lad. this was successfully stented through another procedure. the patient had twice a day hct checks that showed stabilization of his blood counts. he did not require any more transfusions after being transfered to the floor. he did not have chest pain on discharge. the patient will be discharged on aspirin, plavix, coreg, and atorvastatin. . 2. acute blood loss anemia: see above. the patient was discharged with an uptrending hct of 36. . 3. chronic ischemic cardiomyopathy: newly dx'd diastolic dysfuntion on mibi. tte showed global lvh and a ef >55%. the patient was euvolemic during his stay and tolerated the blood transfusions. the patient will continue coreg and imdur. his outpatient cardiologist can decide on starting an acei as an outpatient. . 4. htn: the patient had labile blood pressures after being called out of icu. his coreg was uptitrated to 25mg , but he became hypotensive and orthostatic. this was decreased to 6.25mg in addition to his imdur 30mg qday. the patient had better bp control on this regimen, but had intermittent orthostasis. the patient should have careful bp monitoring as an outpatient and his medications can be changed as needed. the patient was told that he must be careful when changing positions and sit down immediately if he feels dizzy or lightjheaded. . 5. chronic kidney disease: likely due to hypertension and dm2. stable while the patient was here, and he tolerated contrast load with his cath procedure. acei will not be started but this can be added as an outpatient. . 6. bph: continue finasterid . 7. dm: continue levemir 8units qday and januvia. . 8. gerd: continue ranitidine 150mg qday. . transitional issues: - patient will get home pt. he should weigh himself daily. - start an acei as an outpatient if not for chf, then for dm2 - close bp monitoring at home medications on admission: januvia 25 aspirin 325 torpol xl 25 imdur 30 folate 1600 b12 1000 b6 50 vitamin d 1000 mvi finasteride 50 ranitidine 150 levemir 8 units discharge medications: 1. levemir 100 unit/ml solution sig: eight (8) units subcutaneous once a day. 2. januvia 25 mg tablet sig: one (1) tablet po once a day. 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. cyanocobalamin (vitamin b-12) 500 mcg tablet sig: two (2) tablet po daily (daily). 5. pyridoxine 50 mg tablet sig: one (1) tablet po daily (daily). 6. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po daily (daily). 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 9. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 13. polyethylene glycol 3350 17 gram powder in packet sig: one (1) powder in packet po daily (daily) as needed for constipation. 14. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 15. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 16. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 17. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. discharge disposition: home with service facility: discharge diagnosis: unstable angina subclavian artery stenosis acute blood loss anemia ckd dm2 htn 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 hospital with chest pain that was occuring more frequently and at rest. you had a recent stress test that showed an area of narrowing of one of the coronary arteries. you underwent a procedure in which they stented open the coronary artery. after the procedure, you developed a bruise of the groin requiring another stent placement to stop the bleeding. we followed your blood counts and they remained stable after you received some blood transfusions. we performed another procedure to stent open the subclavian artery, which should help increase blood supply to your cabg graft. . after this, you did well. we changed around your blood pressure medications slightly, but you had some episodes of dizziness. then, your bp was high again. your blood pressure medications will be adjusted as an outpatient. . medication changes to note: start plavix 75mg once a day start atorvastatin 80mg once a day switch ranitidine from twice a day to once a day stop metoprolol start carvedilol 6.25mg twice a day decrease aspirin to 81mg once a day followup instructions: name: , s. address: , , , phone: ***the office is working on an appt for you in the next 3-5 days and will call you at home with an appt. if you dont hear from them by tomorrow afternoon, please call them directly to book. department: dermatology when: friday at 11:15 am with: , rn,ms,np building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 1:20 pm with: , md building: campus: east best parking: garage department: vascular surgery when: tuesday at 8:00 am with: vascular lab building: lm bldg () campus: west best parking: garage procedure: coronary arteriography using two catheters left heart cardiac catheterization angioplasty of other non-coronary vessel(s) insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) arteriography of other specified sites arteriography of other specified sites insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel procedure on two vessels diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery esophageal reflux intermediate coronary syndrome pure hypercholesterolemia congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified coronary atherosclerosis of autologous vein bypass graft hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation hematoma complicating a procedure personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease hemorrhage complicating a procedure peripheral vascular complications, 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 acute diastolic heart failure stricture of artery diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled chronic total occlusion of coronary artery cervical spondylosis without myelopathy aneurysm of artery of lower extremity subclavian steal syndrome atherosclerosis of other specified arteries unspecified renovascular hypertension otosclerosis, unspecified 

Answer: The patient is high likely exposed to