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: no known allergies / adverse drug reactions attending: chief complaint: chief complaint: chest pain reason for ccu admission: stemi major surgical or invasive procedure: cardiac catheterizaztion history of present illness: mr. is a 49y/o gentleman with htn, hld, hiatal hernia/gerd and gout who presented to the ed with chest pain and is admitted to the ccu s/p cardiac catheterization after being found to have a stemi. . he is a software programmer and is not very active at baseline, though he walks at work and says he can climb 5 flights of stairs without ever having chest pain but might have mild shortness of breath. he has a hiatal hernia & gerd which causes frequent heartburn. . he was in this usual state of health until 2 days ago when he felt the gradual onset of heartburn/reflux, not associated with exertion or with food. it was persistent and he was surprised that it was not relieved with his ppi or by chewing gum as his usual heartburn is; the pain kept him awake that night. then yesterday around dinnertime the discomfort changed and he began experiencing dull substernal chest pain that was worse with breathing, causing a feeling of shortness of breath because he has been trying to take very shallow breaths. the pain only came on with breathing, and with deep breaths extended to include his /jaw/shoulders. no diaphoresis. the discomfort seemed to be worse when lying down so he slept in a chair. when the pain was still there in the morning he decided to come to the ed. . in the ed, initial vitals were t97.8, hr 88, bp 131/98, rr 16, pox 97% ra. ekg showed i + avl, as well as v2-v6, and q waves in ii, iii, avf and v3-v6. labs were notable for troponin 2.53, cr 1.2, wbc 23.3. he received asa 325mg, plavix 600mg, metoprolol 15mg iv, received a heparin bolus, and was started on an integrillin drip. due to evidence of anterior stemi, he was taken to the cath lab. was found to have lad with diffuse proximal and mid irregularities, distal totally occluded; no collaterals. no intervention was pursued. . on arrival to the floor, patient feels fine but does have chest pain with inspiration, exactly the same as last night and this morning. the pain was not present during the procedure today but is there now. otherwise feels fine. . review of systems 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 pertinent for intermittent ankle swelling (which he says started after starting norvasc, and happens at the end of the day). no dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, palpitations, syncope or presyncope. past medical history: htn hld gout (resolved after stopping diuretics) s/p l4-l5 discectomy s1 radiculopathy social history: -home: lives alone, has no family in the area. close with his brother, who does not live here. friends are his main support. -occupation: software programmer. -tobacco history: never. -etoh: no history of heavy use, and now no etoh due to reflux. -illicit drugs: never. family history: paternal gf died of mi, paternal uncle died of mi in his 50's. brother had an mi last year at age 50. no family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission exam vs: t 99.5, hr 84, bp 141/97, rr 30, pox 92% 2l nc general: overweight gentleman in nad, lying in bed with 2 pillows, breathing comfortably, alert & oriented x3 heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with no jvd. cardiac: pmi non-displaced, s1 and s2, no murmur, no rub, no chest wall tenderness lungs: cta throughout all fields bilaterally abdomen: obese, nondistended, no masses extremities: no edema skin: no stasis dermatitis, ulcers, scars, or xanthomas pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ discharge exam general: 49 yo male in no acute distress heent: perrla, no pharyngeal erythemia, mucous membs moist, no lymphadenopathy, jvp non elevated chest: ctabl no wheezes, no rales, no rhonchi cv: s1 s2 normal in quality and intensity rrr no murmurs rubs or gallops abd: soft, non-tender, non-distended, bs normoactive. no rebound/guarding, neg hsm. neg sign. ext: right radial cath approach, soft, no bleeding/ hematoma/ ecchymosis noted. 2+ radial and ulnar pulses, + csm right hand. no pedal edema, 2+ dp/pts. neuro: cns ii-xii intact. 5/5 strength in u/l extremities. dtrs 2+ bl (biceps, achilles, patellar). sensation intact to lt, pain, temperature, vibration, proprioception. cerebellar fxn intact (ftn, hts). gait normal. skin: no rash, skin intact psych: appropriate pertinent results: admission labs: 11:50am blood wbc-23.3*# rbc-5.17 hgb-15.5 hct-44.5 mcv-86 mch-29.9 mchc-34.8 rdw-12.9 plt ct-311 11:50am blood neuts-87* bands-0 lymphs-5* monos-8 eos-0 baso-0 atyps-0 metas-0 myelos-0 11:50am blood glucose-119* urean-15 creat-1.2 na-140 k-3.5 cl-94* hco3-32 angap-18 cardiac enzyme trend: 11:50am blood ck-mb-66* mb indx-3.2 11:50am blood ctropnt-2.53* 11:50am blood ck(cpk)-2048* 09:57pm blood ck-mb-27* mb indx-2.1 ctropnt-2.08* 09:57pm blood ck(cpk)-1314* discharge labs: 08:20am blood wbc-9.7 rbc-4.06* hgb-11.9* hct-36.4* mcv-90 mch-29.3 mchc-32.8 rdw-12.9 plt ct-235 08:20am blood pt-16.5* ptt-56.5* inr(pt)-1.6* 08:20am blood glucose-95 urean-21* creat-1.2 na-142 k-3.5 cl-102 hco3-34* angap-10 08:20am blood calcium-8.6 phos-3.5 mg-2.3 cardiac risk factor labs: 11:50am blood %hba1c-5.5 eag-111 11:50am blood triglyc-84 hdl-55 chol/hd-3.0 ldlcalc-92 ekg : sinus rhythm. diffuse st segment elevation in the context of evidence of recent or ongoing inferoposterolateral myocardial infarction and probable acute anterior ischemic process as well. clinical correlation is suggested. cxr : as compared to the previous radiograph, there is a substantial decrease in lung volumes. moderate cardiomegaly with signs of mild fluid overload. the presence of a small left pleural effusion cannot be excluded. relatively extensive retrocardiac and left basal atelectasis but no indication for pneumonia. cardiac catheterization : lad with diffuse proximal and mid irregularities, distal totally occluded; no collaterals. no intervention was pursued. tte : the left atrium is mildly dilated. the left atrium is elongated. the estimated right atrial pressure is 0-5 mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is moderately depressed (lvef= 35-40 %) secondary to akinesis of the apex and distal segments of all lv walls. the remaining segments contract normally. no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with moderate regional and global systolic dysfunction c/w cad or takotsubo cardiomyopathy. no significant valvular disease. cxr : 1. improved aeration in the lungs. 2. left basilar atelectasis and small pleural effusion. ekg : sinus rhythm. q waves in leads ii, iii and avf indicating an old inferior myocardial infarction. q waves in leads v4-v6 with st segment elevation in leads v3-v6 and biphasic t waves in lead v2 and that inverted t wave in lead v1 indicating an acute anterior myocardial infarction. however, there are also st segment elevations in leads i, ii, and st segment depressions in lead avr which may indicate a pericarditis process. clinical correlation is suggested. brief hospital course: mr. is a 49y/o gentleman with coronary risk factors of htn, hld, and family history of early cad who presented with stemi. during this admission, his mi was treated medically (no intervention), and he was treated for pericarditis as well as apical aneurysm/akinesis with no complications and he was discharged home. . #. anterior/lateral/inferior stemi: totally occluded distal lad. his "heartburn" 2 days prior to admission that was different from his usual gerd likely represented acs. presented 48 hours out from that event, with no more heartburn (though had pleuritic pain - please see below). q waves already present, no hemodynamic instability or dynamic changes to suggest that intervention at this point would be beneficial (and besides, lesion was 100% occluded) so his stemi was managed medically. his pleuritic pain likely represents post-mi pericarditis (see below). other complications of his mi included apical aneurysm/akinesis (see below). he was monitored in the ccu for more serious complications of stemi, but he had none. note that persistent st elevations could reflect his recent acs, his pericarditis (there are some pr depressions), and/or lv aneurysm. he was discharged on asa (will take anti-inflammatory dose for 1 week then continue with 81mg indefinitely); statin was changed from crestor 5mg to atorvastatin 80mg; his beta blocker (carvedilol) was uptitrated; his raas blocker (losartan) was continued at lower dose. he was plavix-loaded but no indication to continue plavix. he will follow-up with his cardiologist after discharge. . #. peri-infarct pericarditis: still has mild pleuritic chest pain. he has pleuritic chest pain that is somewhat positional, and ekg could be consistent. no rub. no effusion on tte. he is being treated with high-dose asa (650mg po tod x1 week). colchicine was not started; his pain was reasonably controlled on aspirin. . #. apical akinesis, ?lv aneurysm: started on warfarin. tte showed symmetric akinesis of the apex, mild aneurysm as well. he was started on heparin gtt and was transitioned to warfarin (note, was discharged before fully anticoagulated as no clear evidence for bridge). he was discharged on warfarin and will follow up at his cardiologist's office for inr check and management of anticoagulation. . #. lv ef 25-30%: euvolemic on discharge. no intervention was pursued for his lesion but it is possible that his ef will improve somewhat. he is already on a beta blocker and a raas blocker. he will follow up with his cardiologist and will likely have a follow-up tte in the future. . #. mild hypoxia: resolved. he was 88%ra on the morning after presentation. differential included pulmonary edema (mildly depressed ef, but cxr was not very convincing for edema, and he seemed otherwise euvolemic). pe was considered but did not fit with clinical picture and abg was not concerning. with deep breaths his o2 rose to 91%ra; the most likely etiology for his hypoxia was splinting from pericarditis pain, along with likely underlying obesity hypoventilation. his pain was controlled and by the time of discharge his o2 sat was >90%ra. he might benefit from outpatient sleep study. #. leukocytosis: resolved, likely related to mi. no localizing signs/symptoms to suggest infection. leukocytosis likely from mi or pericarditis. cxr was not concerning and his wbc normalized by discharge. #. htn: bp reasonably controlled. he was continued on carvedilol, which was uptitrated for better hr control. as a result, he was able to be discharged off amlodipine. his losartan dose was decreased. he will follow up with his pcp and cardiologist. . #. hld: stable. his statin was chaned from crestor 5mg to atorvastatin 80mg daily. . transitional issues: -pcp /or cardiologist to follow up lipid control (changed from crestor 5mg to atorvaststin 80mg) -cardiologist might wish to repeat tte in the future - benefit from outpatient sleep study -code status this admission: full code -emergency contact: (brother) medications on admission: asa 81mg daily losartan 50mg daily crestor 5mg daily carvedilol 18.75mg norvasc 10mg daily pantoprazole 40mg fish oil 1200mg daily centrum 1 tab daily glucosamine sulfate 1200mg daily coenzyme q-10 100mg daily ibuprofen 800mg prn discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. omega-3 fatty acids capsule sig: one (1) capsule po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. aspirin 325 mg tablet sig: two (2) tablet po tid (3 times a day) for 3 days: until . disp:*18 tablet(s)* refills:*0* 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day: start on and continue indefinitely. disp:*30 tablet, chewable(s)* refills:*2* 6. carvedilol 25 mg tablet sig: two (2) tablet po twice a day. disp:*120 tablet(s)* refills:*2* 7. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 8. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. disp:*30 tablet, sublingual(s)* refills:*0* 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 10. losartan 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: coronary artery disease (s/p st elevation myocardial infarction) peri-infarct pericarditis lv apical aneurysm/akinesis hypertension dyslipidemia gerd discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , it was a pleasure treating you during your hospitalization. you were admitted to after having a heart attack. you have a complete blockage in your left anterior descending artery (lad) which we are treating with medications at this time. as a result of the heart attack you have some apical wall motion abnormalities in your heart which will have to be monitored. because your heart is not pumping normally after the heart attack you need to be cautious about fluid build up. you should weigh yourself every morning and call your doctor if weight goes up more than 3 lbs in 3 days or 5 lbs in 2 days. follow a low salt diet and try to restrict your fluid intake to ml per day. in addition, due to the abnormal movement/shape of the bottom of the heart (apical aneurysm, apical akinesis), you are at risk for blood clot formation in the heart so you are being discharged home on a blood thinner (warfarin). you will need to have the blood level of this medication checked frequently (inr, goal is between 2 and 3). please follow up at dr. office on tuesday to have the blood level checked. the chest pain you are experiencing that is worse with breathing is likely due to "pericarditis," or inflammation of the tissue layer around the heart, which can happen after a heart attack. for this, you are being treated with high-dose aspirin for 1 week (and then you will be decreased to the lower-dose aspirin, which you will continue indefinitely for your coronary artery disease. if you experience chest pressure of atypical heartburn again, take nitroglycerin under your tongue as directed. if the pain does not go away, call 911. medication changes: - stop your norvasc (amlodipine) - stop your crestor - stop taking ibuprofen - decrease your losartan to 25mg daily - increase your carvedilol to 50mg twice daily - increase your aspirin to 650mg three times a day until - after resume aspirin 81mg daily (baby aspirin) - start atorvastatin 80mg daily - start coumadin (warfarin) at 5mg daily: followup instructions: anticoagulation - dr. office ***you will need to have blood work on tuesday to check the inr (measure of blood thinning), electrolytes and kidney function. these should be followed up by dr. . primary care name: , j. location: medical group address: , , , phone: when: thursday, :00 am ***in 6 weeks you will need to have your cholesterol and liver function tests repeated (to make sure the lipitor is working). cardiology name: , /cardiology address: ,ste 7c, , phone: when: wednesday, , 1:00 pm procedure: coronary arteriography using two catheters left heart cardiac catheterization diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux acute myocardial infarction of other anterior wall, initial episode of care gout, unspecified diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia family history of ischemic heart disease hypoxemia painful respiration aneurysm of heart (wall) postmyocardial infarction syndrome thoracic or lumbosacral neuritis or radiculitis, unspecified obesity hypoventilation syndrome 

Answer: The patient is high likely exposed to