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: oxycontin / oxycodone attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization 1. urgent coronary artery bypass graft x4, left internal mammary artery to left anterior descending artery and saphenous vein grafts to diagonal, ramus and obtuse marginal arteries. 2. endoscopic harvesting of the long saphenous vein. history of present illness: this patient is a 74 year old male with pmh of htn, hyperlipidemia, previous coronary stenting, and angina who complains of chest pain. at 10pm, while eating dinner pt felt sharp substernal chest pain () that lasted 1min before it resolved with nitro. pt reports pain radiated to back during this time also. he denies any sob w/ this episode. no n/v. no arm or back pain. no diaphoresis. similar episode happened last week and the pt went into the ed at an osh for this also. the pt was admitted to overnight obs in the ed considering unchanged ekg and negative trop/ckmb. pt has received aspirin in the ed yesterday. repeat ekg this am, showed t waves flipped. past medical history: coronary artery disease pmh: dyslipidemia hypertension obesity current tobacco lbbb severe back pain s/p l4-l5 hemilaminectomy cystoscopy x 2 kidney stones copd sleep apnea - no formal studay - does not use cpap iron deficiency anemia gout bph chronic edema basal cell ca gallstones glucose intolerance past surgical history: s/p 3 back surgeries including l4-l5 hemilaminectomy deviated septum s/p surgical repair bladder stone removal multiple skin cancer removal past cardiac procedures s/p ptci with bare metal stent to proximal lad on balloon angioplasty of instent restenosis to prox lad stenosis in social history: resides with wife in . ambulates with walker due to back pain. -employment:retired security officer. -tobacco history: 40 pack years, stopped in 1/. -etoh: denies -illicit drugs:denies -wife (cell) ; family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission pe vs: t= 97.6 bp= 126/78 hr= 59 rr= 18 o2 sat= 98ra general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: no jvd cardiac: rrr, no r/m/g; distant heart sounds lungs: ctab, but diminished bilaterally abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: 1+ edema in skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: imaging cardiac cath (): 1) selective angiography of this right dominant system demonstrated significant two-vessel coronary artery disease. the lmca had 60% distal vessel stenosis, similar to its appearance on . the lad had 99% in-stent restenosis at the recent angioplasty site, with high-grade stenosis of the ostium of the diagonal branch as well. the dominant lcx had moderate disease. the non-dominant rca was known to have 100% proximal occlusion from the previous catheterization on . 2) limited resting hemodynamics revealed systemic arterial normotension, with a central aortic pressure of 121/65 mmhg. 3) the right common femoral artery arteriotomy site was angiosealed after the case. final diagnosis: 1. severe in-stent restenosis of the proximal lad, involving the ostium of the diagonal branch. 2. cardiac surgery aware and will evaluate the patient. ekg : ii, iii, avf, v3-6 shows new inverted t waves ekg (): showed st elevation in lead v2 w/ st depression in leads v5/v6 and i . intra-op tee conclusions pre-bypass: the left atrium is mildly dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. overall left ventricular systolic function is mildly depressed (lvef= 40-45 %). the right ventricular cavity is mildly dilated with borderline normal free wall function. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque . there are three aortic valve leaflets. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. post cpb: 1. transiently severely depressed lv and rv systolci function. responsded to epinephrine infusion with global -ventricular function improving to baseline. 2. there is mild tr now and mild mr. 3. no other change . 04:25am blood wbc-7.9 rbc-3.08* hgb-9.1* hct-28.3* mcv-92 mch-29.5 mchc-32.1 rdw-12.6 plt ct-333 06:30am blood wbc-7.3 rbc-2.79* hgb-8.4* hct-25.7* mcv-92 mch-30.1 mchc-32.7 rdw-12.8 plt ct-272 04:25am blood urean-28* creat-0.8 na-138 k-4.4 cl-99 06:30am blood glucose-89 urean-29* creat-0.9 na-137 k-4.1 cl-99 hco3-33* angap-9 brief hospital course: medical course: assessment and plan: 74m w/ htn, hlp, former tobacco use, obesity, cad, s/p ptci with bare metal stent to proximal lad on (100% rca occlusion, 60% distal left main, high grade lad lesion with negative flow velocity of left main c/b occlusion of left diagonal) p/w unstable angina. chest pain responded rapidly to nitro making mi less likely especially given negative troponins x2 upon presentation. initial ekg showed no changes, but ekg in ed the morning after showed inverted t waves in several leads. planned to treat ua medically and cath on monday. on , the pt experienced multiple episodes of cp in the morning. all relieved w/ slng. trops cont be neg, but st elevation seen on ekg in lead v2 w/ st depression in v5/6. . # coronaries: pt w/ bms to prox lad s/p recent angioplasty, p/w likely ua. his medications were optimized by continuing asa 325 daily, imdur 30mg , lisinopril 20mg daily, atenolol 25mg daily, plavix 75mg daily. simva 40mg daily was changed to atorvastatin 80mg daily although to note ldl is at goal at 49, but hdl low at 24. the pt was started on a heparin gtt. the pt w/ more episodes of angina, all w/ exertion on . relieved w/ slng, but started on nitro drip given multiple episodes. trop neg x6, but concern for ischemia given changes in ekg. pt taken to cath which showed restenosis of prox lad. csurg was contact for eval for cabg. plavix was stopped w/ last dose on . bp was regulated on nitro gtt. pt transferred off cards service on after pt sent for cabg. surgical course: the patient was brought to the operating room on where the patient underwent urgent cabg x 4 with dr. . overall the patient tolerated the procedure well and post-operatively was transferred to the cvicu in stable condition for recovery and invasive monitoring. pod 1 found the patient extubated, alert and oriented and breathing comfortably. the patient was neurologically intact and hemodynamically stable, weaned from inotropic and vasopressor support. he was subsequently re-intubated on pod 1 and weaned and extubated shortly after. beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. the patient was transferred to the telemetry floor for further recovery. chest tubes and pacing wires were discontinued without complication. foley was re-inserted for urinary retention. he will be discharged with the foley for a void trial in the future. the patient was evaluated by the physical therapy service for assistance with strength and mobility. by the time of discharge on pod 6 the patient was ambulating freely, the wound was healing and pain was controlled with oral analgesics. the patient was discharged rehab in good condition with appropriate follow up instructions. medications on admission: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) inhalation every six (6) hours as needed for shortness of breath or wheezing. 2. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 40 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 4. gabapentin 300 mg capsule sig: one (1) capsule po twice a day. 5. hydrocodone-acetaminophen 5-500 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. 6. lisinopril 10 mg tablet sig: two (2) tablet po once a day. 7. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual once a day as needed for chest pain: take every 5 minutes, if you use more than 2 please notify your physician . 8. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): do not miss of this medication. 9. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 10. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 11. plavix 75 mg tablet sig: one (1) tablet po once a day for 3 . discharge medications: 1. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 2. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for wheezes. 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q4h (every 4 hours) as needed for wheezes. 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 6. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). 7. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 8. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. cepacol sore throat 15-2.6 mg lozenge sig: one (1) mucous membrane q 1 hr as needed for sore throat. 12. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 13. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 14. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. 15. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day) for 10 days. 16. potassium chloride 10 meq tablet extended release sig: two (2) tablet extended release po q12h (every 12 hours) for 10 days. 17. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours). discharge disposition: extended care facility: rehab & nursing center - discharge diagnosis: coronary artery disease pmh: dyslipidemia hypertension obesity current tobacco lbbb severe back pain s/p l4-l5 hemilaminectomy cystoscopy x 2 kidney stones copd sleep apnea - no formal studay - does not use cpap iron deficiency anemia gout bph chronic edema basal cell ca gallstones glucose intolerance past surgical history: s/p 3 back surgeries including l4-l5 hemilaminectomy deviated septum s/p surgical repair bladder stone removal multiple skin cancer removal past cardiac procedures s/p ptci with bare metal stent to proximal lad on balloon angioplasty of instent restenosis to prox lad stenosis in discharge condition: alert and oriented x3 nonfocal ambulating, deconditioned sternal pain managed with oral analgesics sternal incision - healing well, no erythema or drainage edema: 2+ discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments: surgeon dr. , date/time: 1:00 please call to make an appt with: cardiologist/pcp . , j. **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters enteral infusion of concentrated nutritional substances diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery intermediate coronary syndrome tobacco use disorder unspecified essential hypertension gout, unspecified percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) other left bundle branch block other emphysema other complications due to other cardiac device, implant, and graft retention of urine, unspecified iron deficiency anemia, unspecified surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation obesity, unspecified other abnormal glucose pain in joint, shoulder region other fluid overload thoracic or lumbosacral neuritis or radiculitis, unspecified body mass index 34.0-34.9, adult 

Answer: The patient is high likely exposed to