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: penicillins attending: chief complaint: chest pain, shortness of breath major surgical or invasive procedure: cardiac catherization coronary artery bypass grafting x 5 (svg "y" to diag and lima to lad; svg to rpl; svg "y" to ramus and svg to om) history of present illness: ms. is a 64 year old woman with known coronary artery disease s/p non-st elevation myocardial infarction in (medically managed), and stroke who presented to an outside hospital two days ago with chest discomfort. patient was ruled out for mi there and was transferred to for cardiac catheterization. no plavix was given. patient reports some decreased exercise tolerance over the past 3-4 months (used to walk 3 miles and now feels short of breath walking shorter distances). she was walking up a one day prior to admission from osh and reports feeling chest pressure like "someone sitting on her chest" with pain radiating to her l arm. reports some minor l calf pain as well. +sob. no other associated symptoms such as nausea/vomiting/dizziness/diaphoresis/lh/loc. different from her previous anginal symptoms in (diaphoresis, sscp with radiation to her l arm). pressure continued for a few hours and never completely resolved with sl nitro. previous chest pain/pressure has resolved with nitro in the past. patient walked to a cvs afterwards and took her blood pressure and found it to be quite hypertensive 190/101. patient reports not taking her nifedipine, but is compliant with her other medications. patient also had an episode of epistaxis which resolved. she is not taking any anticoagulation currently. denies sob, pnd, or orthopnea, or lower extremity edema. no history of dvt or pe. . patient was admitted to osh and ruled out for an mi. ekg was without acute ischemic changes. she was noted on chest ct to have no pe but with chf and cardiomegaly. she was given 60 mg iv lasix and continued on 20 po lasix. started on . she was then transferred to for cardiac catherization. found to have 3vd including critical left main disease (60%), lcv 80% ostial, rca with 60%, ramus 80% ostial. ct surgery was consulted and have recommended cabg. patient was transferred to the floor s/p catherization: she denied any chest pain, shortness of breath, or pain at her catherization site. she has not received any plavix. past medical history: htn cad nstemi hemorrhagic cva years ago without intervention asthma gerd hiatal hernia gastric ulcers cardiac risk factors: (-)diabetes, (+)dyslipidemia, (+)hypertension, (+) smoker . cardiac history: pci in : 2 vessel coronary artery disease. no intervention performed. social history: social history is significant for the absence of current tobacco use (patient is a former smoker with a > 60 ppy history). there is no history of alcohol abuse. family history: there is a family history of premature coronary artery disease or sudden death (father had 3 , first at 63, sister with rheumatic fever and mi at 30, sister with leukemia.) physical exam: vs - 98.7 62 110/63 16 93% on ra gen: elderly f sitting up in a chair, nad heent: ncat. sclera anicteric. anisocoria (r pupil 4 mm, l pupil 2 mm, perrla). eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. no lad. neck: supple with jvp of 3 cm at 60' angle. cv: pmi at 5/6 ic space. rrr, s1/s2 heard. soft sm murmur heard best at the bases. chest: slight crackles at bases. abd: soft, ntnd. no hsm or tenderness. no g/rt. no hsm. ext: no lower extremity edema. groin site: bandage c/d/i. no hematoma. gross sensation/movement intact. cap refill < 2 secs. . pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ pertinent results: ekg: sinus brady; na, ni, twi in i, avl, twf in avf, no acute ischemic changes. echocardiography report , (complete) done at 9:40:40 am final referring physician information , r. , division of cardiothorac , status: inpatient dob: age (years): 64 f hgt (in): 60 bp (mm hg): 126/68 wgt (lb): 127 hr (bpm): 58 bsa (m2): 1.54 m2 indication: intra-op tee for cabg icd-9 codes: 786.05, 786.51, 440.0 test information date/time: at 09:40 interpret md: , md, md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2008aw01-: machine: echocardiographic measurements results measurements normal range left ventricle - ejection fraction: 50% >= 55% findings right atrium/interatrial septum: normal interatrial septum. no asd or pfo by 2d, color doppler or saline contrast with maneuvers. left ventricle: normal lv wall thickness and cavity size. low normal lvef. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. focal calcifications in aortic root. normal ascending aorta diameter. normal aortic arch diameter. normal descending aorta diameter. simple atheroma in descending aorta. aortic valve: three aortic valve leaflets. no as. no ar. mitral valve: no ms. mr. tricuspid valve: physiologic tr. pulmonic valve/pulmonary artery: physiologic (normal) pr. pericardium: no pericardial effusion. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the patient was under general anesthesia throughout the procedure. no tee related complications. the patient appears to be in sinus rhythm. results were personally reviewed with the md caring for the patient. see conclusions for post-bypass data the post-bypass study was performed while the patient was receiving vasoactive infusions (see conclusions for listing of medications). conclusions pre-bypass: 1. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or agitated saline contrast with valsalva release maneuver. 2. left ventricular wall thicknesses and cavity size are normal. overall left ventricular systolic function is low normal within transient mild apical hypokinesis (lvef 50-55%). 3. right ventricular chamber size and free wall motion are normal. 4. there are simple atheroma in the descending thoracic aorta. 5. there are three aortic valve leaflets. there is no aortic valve stenosis. no aortic regurgitation is seen. 6. no mitral regurgitation is seen. 7. there is no pericardial effusion. dr. was notified in person of the results. post-bypass: for the post-bypass study, the patient was receiving vasoactive infusions including phenylephrine and is being a paced. 1. biventricular function is preserved 2. aorta is intact post decannulation. 3. other findings are unchanged i certify that i was present for this procedure in compliance with hcfa regulations. electronically signed by , md, md, interpreting physician 13:04 . c.cath study date of *** not signed out *** brief history: 64 yo wf with pmh of htn/cad s/p nstemi in on medical management began to develop exertional chest pain. admitted to hospital with negative cardiac markers and no ecg changes. given past lhc in with moderate cad, referred for re-evaluation. indications for catheterization: coronary artery disease, canadian heart class iii, stable. procedure: conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. hemodynamics results body surface area: 1.53 m2 hemoglobin: 12.6 gms % fick **pressures right atrium {a/v/m} right ventricle {s/ed} 36/12 pulmonary artery {s/d/m} 33/16/25 pulmonary wedge {a/v/m} 19/19/16 left ventricle {s/ed} 132/20 aorta {s/d/m} 132/69/96 **cardiac output o2 cons. ind {ml/min/m2} 125 a-v o2 difference {ml/ltr} 24 card. op/ind fick {l/mn/m2} 8.0/5.2 **resistances systemic vasc. resistance 850 pulmonary vasc. resistance 90 **% saturation data (nl) pa main 77 ao 91 left ventriculography: volumetric data: lv ejection fraction (nl 50%-80%). 60 qualitative wall motion: : 1. antero basal - normal 2. antero lateral - normal 3. apical - normal 4. inferior - normal 5. postero basal - normal other findings: mitral valve was normal. aortic valve was normal. **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca normal 2) mid rca normal 2a) acute marginal normal 3) distal rca normal 4) r-pda normal 4a) r-post-lat discrete 60 4b) r-lv normal **arteriography results morphology % stenosis collat. from **left coronary 5) left main discrete 60 6) proximal lad normal 6a) septal-1 normal 7) mid-lad normal 8) distal lad normal 9) diagonal-1 normal 10) diagonal-2 normal 11) intermedius discrete 80 12) proximal cx discrete 80 13) mid cx normal 13a) distal cx normal 14) obtuse marginal-1 normal 15) obtuse marginal-2 normal 16) obtuse marginal-3 normal technical factors: total time (lidocaine to test complete) = 40 minutes. arterial time = 30 minutes. fluoro time = 8 minutes. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 95 ml, indications - renal anesthesia: 1% lidocaine subq. anticoagulation: other medication: versed 0.5mg iv x 2 doses fentanyl 25mcg iv x 2 doses nitroglycerine 100mcg ic x 2 doses cardiac cath supplies used: - allegiance, custom sterile pack - , left heart kit 5fr , multipack 5fr cordis, tip sheath 11cm comments: 1. selective coronary angiography of this right dominant system demonstrated critical lmca and 2 vessel cad. the lmca has a 60% distal eccentric lesion. the lad has insignificant plaquing. the ostial lcx has a 80% stenosis. the rca has a 60% large 2nd pl branch stenosis. the ramus has a 80% lesion at its ostia. 2. subselective angiography demonstrated a patent lima suitable for pending cabg. 3. resting hemodynamic measurement demonstrated elevated filling pressures with a rvedp of 12 mmhg and lvedp of 20 mmhg. the mean pcwp was mildly elevated at 16 mmhg. the mean pap was normal at 25 mmhg. pullback of the catheter from the lv across the aortic valve did not demonstrate a pressure gradient. the calculated fick cardiac index was 5.2 l/min/m2. 4. left ventriculography revealed a calculated ef of 60%. final diagnosis: 1. critical lmca and two vessel coronary artery disease. 2. normal ventricular function. 3. referred for cabg. attending physician: , . referring physician: , . cardiology fellow: , attending staff: , a. () brief hospital course: mrs was referred for cardiac surgical intervention and she was brought to the operating room on where she underwent coronary artery bypass grafting x5. this procedure was performed by dr. . please see operative note for complete details. post-operatively she was admitted to the cardiac surgery intensive care unit for invasive hemodynamic monitoring. she was extubated during post-operative day 1. she remained on neosynephrine for several days post-operatively. her chest tubes and wires were removed. she was placed on amiodarone for atrial fibrillation. by post-operative day four she was ready for transfer to the surgical step down floor. she was started on a low-dose ace inhibitor for a compromised ejection fraction. she was seen by physical therapy in consultation to work on strength and balance. by post operative day 6 she was ready for discharge to home. medications on admission: lipitor 80 mg po daily irbesartan (avapro) 150 mg po daily metoprolol 50 mg po bid nifedipine 60 sr mg po daily nexium 40 mg po daily asa 81 mg po daily discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 2. lipitor 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*30 capsule(s)* refills:*0* 4. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for chest pain. disp:*60 tablet(s)* refills:*0* 5. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. lasix 20 mg tablet sig: one (1) tablet po once a day for 7 days. disp:*20 tablet(s)* refills:*0* 7. amiodarone 200 mg tablet sig: two (2) tablet po once a day: take 400 mg (2 tablets) daily for 7 days and then taper down to 200 mg (1 tablet) daily. disp:*90 tablet(s)* refills:*0* 8. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*40 tablet(s)* refills:*0* 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 10. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: two (2) puff inhalation every 4 hours as needed as needed. disp:*qs qs* refills:*0* 11. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po once a day for 7 days. disp:*14 tab sust.rel. particle/crystal(s)* refills:*0* 12. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* 13. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day): please rinse your mouth and spit it out after every use. disp:*qs qs* refills:*0* discharge disposition: home with service facility: discharge diagnosis: coronary artery disease s/p cabg x5 nstemi hypertension gerd with gastric ulcers cva (hemorrhagic)11 years ago (r arm residual weakness) hiatal hernia discharge condition: good discharge instructions: please shower daily including washing incisions, no baths or swimming monitor wounds for infection - redness, drainage, or increased pain report any fever greater than 101 report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week no creams, lotions, powders, or ointments to incisions no driving for approximately one month no lifting more than 10 pounds for 10 weeks please call with any questions or concerns followup instructions: dr. in 4 weeks () please call for appointment dr. in 1 week () please call for appointment dr. in weeks. please call for appointment wound check appointment 2 as instructed by nurse () procedure: venous catheterization, not elsewhere classified single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters angiocardiography of left heart structures diagnostic ultrasound of heart (aorto)coronary bypass of four or more coronary arteries injection or infusion of other therapeutic or prophylactic substance other conversion of cardiac rhythm transfusion of packed cells diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery esophageal reflux intermediate coronary syndrome unspecified essential hypertension cardiac complications, not elsewhere classified atrial fibrillation asthma, unspecified type, unspecified diaphragmatic hernia without mention of obstruction or gangrene surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation old myocardial infarction personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits hypovolemia acquired absence of both cervix and uterus 

Answer: The patient is high likely exposed to