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: chest pain major surgical or invasive procedure: cardiac catheterization. history of present illness: 80 year-old female with past medical history of hypertension but without known history of cad, diabetes, or hyperlipidemia presenting with complaints of sscp x 3 hours prior to presentation at . the chest pressure was nonradiating and was without any associated symptoms. ecg consistent with ste imi. the patient received asa 325 mg, plavix 600 mg, lopressor 7.5 iv x1, sln x3, heparin bolus and gtt. the patient was transferred to for cardiac catheterization. . cardia cath results : co 4.21, ci 2.55. lmca: mild disease, lad 80% stenosis, lcx 90% serial lesions, rca 99% with slow flow -> stented with vision stent-> 0% residual. distal 40% left alone and a small dye stain worrisome for wire perforation noted. stat bedside echocardiogram showed no evidence of fluid collection or tamponade. during catheterization, she received 500 mcg of diltiazem and developed a transient asystole which resolved without any intervention. . the patient previously had three episodes of exertional chest pressure relieved wtih rest over the past three weeks. at baseline, however, she can walk 2 miles without any anginal symptoms or shortness of breath. . currently, patient is chest pain free and has no new complaints. the patient denies orthopnea, pnd, lower extremity edema. review of systems otherwise negative in detail. past medical history: 1. hypertension 2. rheumatic heart disease as child without any residual murmur 3. diverticulitis 4. right breast cancer status post lumpectomy 5. bladder suspension social history: pt denies tobacco use. she drinks one glass of wine daily family history: father had an mi at age 59. no sudden death in the patient's family. physical exam: vital signs: bp 142/79 hr 70 rr 16 pulsus 6. general: wdwn elderly female in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis. neck: supple with no jvd. heart: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. respirations were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abdominal aorta not enlarged by palpation. no abdominial bruits. extemities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ dp 2+ pt dopplerable left: carotid 2+ femoral 2+ dp 2+ pt dopplerable pertinent results: labwork on admission: 10:00pm hgb-11.6* calchct-35 o2 sat-93 10:00pm glucose-137* k+-3.4* 10:00pm type-art o2-21 o2 flow-2 po2-68* pco2-38 ph-7.42 total co2-25 base xs-0 11:07pm pt-13.5* ptt-110.0* inr(pt)-1.2* 11:07pm plt count-260 11:07pm wbc-11.0 rbc-3.65* hgb-12.1 hct-33.8* mcv-93 mch-33.1* mchc-35.8* rdw-12.9 11:07pm albumin-4.0 calcium-8.1* phosphate-2.4* magnesium-2.0 11:07pm ck-mb-39* mb indx-11.6* ctropnt-1.38* 11:07pm ck(cpk)-335* 11:07pm glucose-134* urea n-10 creat-0.6 sodium-132* potassium-3.8 chloride-101 total co2-22 anion gap-13 11:15pm %hba1c-6.0* -done -done . ecg study date of 10:15:56 pm sinus rhythm. consider left atrial abnormality. inferior myocardial infarction with st-t wave configuration suggesting acute/recent/in evolution process. clinical correlation is suggested. no previous tracing available for comparison. . c.cath study date of *** not signed out *** brief history: 80 year old woman with hypertension presents with substernal chest pain for 3 hours to an outside hospital. ekg showed 3mm inferior st elevations. she was referred to emergent cardiac catherization for stemi. indications for catheterization: coronary artery disease, canadian heart class iv, unstable. 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 left catheter, advanced to the ascending aorta through a 6 french introducing sheath. coronary angiography: was performed in multiple projections using a 5 french jl4 and a 5 french 0.75 catheter, with manual contrast injections. 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: 1.65 m2 hemoglobin: 14.4 gms % fick **pressures right atrium {a/v/m} 13/11/9 right ventricle {s/ed} 30/10 pulmonary artery {s/d/m} 27/14/20 pulmonary wedge {a/v/m} 21/14/14 left ventricle {s/ed} 175/25 aorta {s/d/m} 181/81/121 **cardiac output heart rate {beats/min} 65 rhythm sinus o2 cons. ind {ml/min/m2} 125 a-v o2 difference {ml/ltr} 49 card. op/ind fick {l/mn/m2} 4.2/2.6 **resistances systemic vasc. resistance 2133 pulmonary vasc. resistance 114 **% saturation data (nl) pa main 70 ao 95 **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca discrete 99 **arteriography results morphology % stenosis collat. from **left coronary 5) left main normal 6) proximal lad diffusely diseased 80 6a) septal-1 normal 7) mid-lad normal 8) distal lad normal 9) diagonal-1 normal 12) proximal cx normal 13) mid cx normal 13a) distal cx normal 14) obtuse marginal-1 diffusely diseased 90 15) obtuse marginal-2 normal **ptca results rca **baseline stenosis pre-ptca **technique guiding cath 6f jr4 guidewires cptxs initial balloon (mm) 2 final balloon (mm) 3.25 # inflations 3 max pressure (psi) 270 **result stenosis post-ptca 0 success? (y/n) y ptca comments: the angiogram showed a mid rca lesion of 99 percent with slow flow. we planned to stent this lesion. we used heparin, aspirin and clopidogrel prophylactically. a 6f jr 4 guide provided adequte support. a choice pt xs wire crossed in to the distal vessel easily. the lesion was predilated with a 2.0 x 20mm maverick balloon at10 atm. we then deployed a 3.0 x 28 mm vision stent in to the lesion at14 atm. the stent was post dilated with a 3.25 x 15 mm maverick balloon up to 16 atm. the final angiogram showed timi iii flow with no residual stenosis, no dissection, no perforation and no embolisation. the patient left the lab in a stable condition. technical factors: total time (lidocaine to test complete) = 0 hour41 minutes. arterial time = 0 hour40 minutes. fluoro time = 15 minutes. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 180 ml, indications - renal anesthesia: 1% lidocaine subq. anticoagulation: heparin 1500 units iv other medication: atropine 1.5mg iv diltiazem 500mcg ic fentanyl 25mcg iv heparin drip 800u/hr iv nitroglycerin bolus 200mcg ic nitroglycerine drip 60mcg/min iv cardiac cath supplies used: .014 , choice pt xs, 300cm 2.0 , maverick, 20 3.25 , quantum maverick, 15 6f cordis, jr 4 sh 6f cordis, .75 6f cordis, h-stick sh 3.0 guidant, vision rx, 28 - allegiance, custom sterile pack 6f , ar2 - guidant, priority pack 20/30 comments: 1. selective coronary angiography of this right dominant system revealed severe three vessel disease. the lmca has mild disease. the proximal lad had an area of diffuse 80% stenosis. the lcx has a large om1 with serial 90% stenosis. the prca has a 99% lesion with slow flow. 2. resting hemodynamic measurements revealed mildly elevated biventricular filling pressure, normal cardiac output and marked hypertension. 3. left ventriculogram was deferred since left ventricular function will be assessed non-invasively. 4. the lesion in the mid /proximal rca was predilated with a 2.0 mm balloon, stented with a 3.0 mm bre meal stent and post dilated with a 3.25 mm balloon with lesion reduction to 0%. the final angiogram showed timi iii flow with no residual stenosis, no dissection, no perforation and no embolisation. (see ptca comments) 5. of note, a region of blush in the rv was noted. however, this region is distant from any wire used during the intervention. bedside echocardiogram did not reveal any pericardial effusion. final diagnosis: 1. severe three vessel coronary artery disease 2. mildly elevated biventricular pressure with normal cardiac output 3. marked systemic hypertension. 4. successeful stenting of the rca (bare metal) in the setting of acute inferior stemi. . echo study date of conclusions: left ventricle - ejection fraction: >= 70% (nl >=55%) left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). transmitral doppler and tissue velocity imaging are consistent with grade i (mild) lv diastolic dysfunction. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . dup extext bil (map/dvt) impression: patent bilateral greater saphenous veins. . carotid series complete impression: 1. no evidence of internal carotid artery stenosis on the right side. 2. less than 40% stenosis in the left internal carotid artery. . ecg study date of 10:29:02 am sinus rhythm with occasional atrial ectopy. prior inferior myocardial infarction. compared to the previous tracing of atrial ectopy has appeared. there is further evolution of recent or ongoing inferior wall myocardial infarction. otherwise, no diagnostic interim change. . labwork on discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:50am 10.5 3.85* 12.5 36.1 94 32.5* 34.6 13.5 297 renal & glucose glucose urean creat na k cl hco3 angap 06:50am 104 10 0.6 138 3.9 101 27 14 brief hospital course: 80 year-old female transferred from osh with chest pain, found to have inferior stemi s/p pca to rca. . 1. coronary artery disease/ischemia. stemi in inferior territory now s/p rca bare metal stent to 99% lesion. the patient was noted to have lad and lcx lesions as above that were not revascularized at the time of cath. the patient was continued on aspirin and started on plavix and high-dose statin. the patient was restarted on beta-blocker and ace-inhibitor prior to discharge. cardiac enzymes peaked at ck 458. the patient was followed by cardiac surgery and plans made for cabg once the patient was on plavix for one month after stenting. the patient received pre-operative evaluation with carotid ultrasound and vein mapping. the patient will follow-up with her outpatient cardiologist and with cardiac surgery. . 2. pump. echocardiogram as above showed ef 70%, mild diastolic failure, and no wall motion abnormalities. the patient remained euvolemic. the patient was restarted on a beta-blocker as above. . 3. rhythm. the patient remained in normal sinus rhythm without events on telemetry. the patient was restarted on a beta-blocker as above. . 4. av-fistula/question right ventricular perforation. after intervention, the patient was noted to have a blush in the rv. this likely represented an av-fistula not seen prior to intervention. the patient remained hemodynamically stable with stat bedside echocardiogram not showing fluid collection or signs of tamponade. repeat echocardiogram also negative for fluid collection or signs or tamponade. . 5. hypertension. the patient was restarted on her outpatient regimen. . 6. code: full . 7. disposition: home medications on admission: asa 325mg qday vasotec 10 mg qd atenolol 75 mg qd discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. enalapril maleate 10 mg tablet sig: one (1) tablet po daily (daily). 5. atenolol 25 mg tablet sig: three (3) tablet po daily (daily). 6. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. discharge disposition: home with service facility: vna discharge diagnosis: primary: 1. st-elevation inferior myocardial infarction 2. mild diastolic heart failure . secondary: 1. hypertension 2. rheumatic heart disease as child without any residual murmur 3. diverticulitis 4. right breast cancer status post lumpectomy 5. bladder suspension discharge condition: afebrile, vital signs stable. discharge instructions: you were hospitalized with a heart attack. it is very important you take your medications as prescribed. you should follow a cardiac diet and should follow the activity guidelines provided. . please contact a physician if you experience fevers, chills, chest pain or pressure, shortness of breath, or any other concerning symptoms. . please take your medications as prescribed. - you should continue aspirin 325 mg daily. - you were started on plavix 75 mg daily; you should discontinue plavix four days prior to surgery as directed. - you were started on atorvastain 80 mg daily. - you should continue atenolol 75 mg daily. - you should continue vasotec 10 mg daily. . please contact your primary care physician/cardiologist, dr. , at to schedule a follow-up appointment within the next month. . please contact the office of dr. in cardiac surgery at if you have any questions or concerns. a representative from his office will be in contact with you. followup instructions: please contact your primary care physician/cardiologist, dr. , at to schedule a follow-up appointment within the next month. . please contact the office of dr. in cardiac surgery at if you have any questions or concerns. a representative from his office will be in contact with you. procedure: insertion of non-drug-eluting coronary artery stent(s) combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of right heart structures cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled personal history of malignant neoplasm of breast other and unspecified hyperlipidemia acute myocardial infarction of other inferior wall, initial episode of care acute diastolic heart failure 

Answer: The patient is high likely exposed to