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: nsaids / bupivacaine / sulfa (sulfonamides) / penicillins attending: chief complaint: syncope major surgical or invasive procedure: cardiac catheterization and placement of bare metal stent in lad history of present illness: in brief pt is 86f with copd, diastolic chf, dvt, ra and multiple admissions in the past for syncope, who presents after a syncopal episode. she was at the laundromat at the day of admissoon when she experienced the usual prodrome, which is weakness and lightheadedness,. she usually manages to sit down, however this time she passed out and found her self surrounded by ems. she endorses progressive weakness and lightheadedness over the past few weeks. she has not been evaluated by a cardiologist and has not had a holter. initially she denied cp but lateron admitted to some chest pressure since her admission, sob. . in the ed was noted to be initially hypotensive to 80/40 wth pulse 60 though the bp came up and remained stable for the duration of the ed course. the patient was noted to be somnolent and was intubated for airway protection as she was vomiting. ct head, neck, abdomen, and pelvis wnl. no pe. x-ray showing lateral malleolar fracture, seen by ortho to be conservatively managed. patient was than transferred to icu, respriratory function remained stable, blood pressure responded to fluids (1.5 liter +) and did not require any further intervention. during icu stay patient had mild troponin elavation with normal ck, new diffuse t wave inversions with old lbbb, and echo suggestion new global systolic dysfunction. patient called out to floor, for further managment and evaluation of syncope. past medical history: hypothyroidism osteopenia h/o congestive heart failure, though ef nl by tte on past admission rheumatoid arthritis hypertension bilateral l5/s1 lumbar radiculopathy by emg endometrial thickening s/p d&c h/o dvt when she delivered her son by social history: widowed, lives alone and is independent in adls doing groceries for herself. worked as a bookkeeper when she was young. smoked for many years then quit. no etoh use. per daughter fully functional family history: non-contributory physical exam: vs: temp: 98.3 bp: 104/58 hr: 78 rr: 18 o2sat: 100% 3l nc gen: pleasant, comfortable, nad heent: perrl, eomi, mmm, op clear resp: cta b/l cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt ext: no c/c/e pertinent results: inr 1.1 / ptt 24.7 wbc 7.5 / hct 33.8 / plt 300 n 67 l 24 m 6 e 2 serum tox - negative urine tox - positive for benzodiazepines tsh 4.9 na 140 / k 4.5 / cl 106 / co2 25 / bun 23 / cr 1.2 / bg 113 ca 9.8 / phos 2.9 / mg 1.9 / alb 3.7 ck 30 / mb not done / trop t < .01 ua - 0 rbcs, 11-20 wbcs, 0 bacteria, epis urine culture - negative - right ankle xr - lateral malleolar fracture. - ct c spine - no fracture or acute alignment abnormality. these findings were posted to the ed dashboard at approximately 2:30 p.m. on . - ct head - 1. no fracture, hemorrhage, or evidence of acute injury. 2. chronic small-vessel ischemic disease. 3. age-related involutional changes. - cta chest/abd/pelvis - 1. no evidence of traumatic injury to the chest, abdomen, or pelvis. 2. stability over time of left adnexal cystic lesion favors a benign etiology, although clinical correlation is advised. 3. no evidence of pulmonary embolus or aortic dissection. - echo the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with hypokinesis of the distal septum and apex. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a fat pad. cardiac catheterization - 1. selective coronary angiography of this right dominant system demonstrated single vessel coronary artery disease. the lmca was patent. the lad had a 70% stenosis in the mid vessel. the lcx was patent. the rca had a 50% stenosis in the mid vessel. 2. limited resting hemodynamics were performed. the systemic arterial pressures were elevated measuring 177/78mmhg. 3. successful ptca/stent to mid lad with a 2.5x18mm minivision stent deployed at 14atms. excellent result with normal flow down vessel and no residual stenosis. final diagnosis: 1. one vessel coronary artery disease. 2. elevated systemic arterial pressures. 3. successful ptca/stent to mid lad with bare metal stent. - ruq us no evidence of cholelithiasis or cholecystitis. brief hospital course: mrs. is an 86f with copd, diastolic chf, remote h/o dvt, and ra who presents following an episode of chest tightness and syncope found to have new wall motion abnormality and ekg changes c/w ischemia, as well as an elevated troponin, now s/p cardiac cath and placement of a bms to lad. 1)nstemi - she has had chest pressure intermittently during this admission with dynamic t wave changes consistent with myocardial ischemia. she also had an echocardiogram which showed new wall motion abnormality. she was taken to the cardiac cath lab for further evaluation which showed a 70% lad lesion which was treated with a bms. she did well following cardiac catheterization with no elevation of ck post cath. she did have a right groin hematoma post cath that was stable with no bruit on exam. she was continued on plavix, aspirin, atorvastatin and metoprolol post cardiac cath. 2)syncope: she has had multiple episodes of syncope over the past several years with significant prodrome of nausea, vomiting diaphoresis, blurry vision/lightheadedness. most likely cause is vasovagal syncope given her significant and predictable prodrome. ddx also include cardiac arrhythmia such as vt/vf or bradyarrhythmia however this has not been seen on telemetry during her current or prior admissions. no evidence of severe as or obstructive cardiomyopathy on echo. vertebrobasilar insufficiency also possible as is adrenal insufficiency however less likely given her normal electrolyte profile and normal cta head/neck in . in addition, she has not had any recent changes in her prednisone dose. 3)right ankle fracture: s/p fall, has been followed by orthopedics with no current plan for surgery. she has an aircast splint and can weight bear as tolerated. she has follow up scheduled with dr. in clinic. she was continued on lovenox for vte prophylaxis given that she is relatively immobilized in the aircast splint. she was discharged to rehab. 4)ruq/r sided chest pain - following her cardiac cath she had several episodes of severe pain on the r side of her chest and upper abdomen bilaterally with associated nausea. given her recent cath this was initially concerning for instent thrombosis, however there was no evidence to support this on ekg, vital signs remained stable, no pulsus paradoxus, ck stable. pain was reproducible with palpatin or ruq/right lower ribs. pain/chest heaviness may also be due to volume overload in setting of her diastolic dysfunction. she had lft's that were normal, ruq ultrasound which did not show evidence of cholelithiasis or cholecystitis. no evidence of rle dvt. she is also constipated with no bm in one week. she was started on protonix (given that she is on asa and prednision), maalox/lidocaine and her bowel reg was titrated up with symptom improvement. 5)htn: blood pressure was elevated at 140's-180 during her admission and her antihypertensive regimen was titrated up. she was continued on lisinopril 10mg daily and metoprolol 50mg daily. 6)rheumatoid arthritis:stable,no acute issues, she was continued on her home dose prednisone. 7)hyperthyroid: she had a slight elevation in tsh however no changes were made in her thyroid replacement dose during this admission. 8)ppx: lovenox, bowel reg, ppi 9) full code medications on admission: lisinopril 10' synthroid 50 mcg' prednisone 2.5' vit d 400 timolol eye gtt discharge medications: 1. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours). 2. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 3. prednisone 5 mg tablet sig: 0.5 tablet po daily (daily). 4. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 5. enoxaparin 30 mg/0.3 ml syringe sig: thirty (30) mg subcutaneous q12h (every 12 hours): while immobilized. disp:*1800 mg* refills:*2* 6. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 8. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 9. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. prilosec 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:*2* 12. oxycodone 5 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for as needed for pain. 13. docusate sodium 100 mg capsule sig: capsules po bid (2 times a day). 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 15. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 16. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. discharge disposition: extended care facility: of discharge diagnosis: nstemi ========== hypothyroidism rheumatoid arthritis syncope hypertension hyperlipidemia discharge condition: fair discharge instructions: you were admitted to the hospital after you fainted and were found to have a fracture of your right ankle. you were recommended to wear the ankle boot (may take off for bathing and to assess skin breakdown) and follow-up in orthopedics clinic. you were also having chest pain and concerning changes on your ekg. you had cardiac catheterization and had a stent placed to open up one of your heart arteries. you did well after your catheterization. your blood pressure was elevated and you were started on a new medicine to help improve your blood pressure. medications: 1) you were started on a new medication called metoprolol for your high blood pressure. 2) you were started on plavix which you need to take every single day until your doctor tells you that you can stop it. it is very important that you not miss a day of this medication as it could cause closure of your stent and a serious heart attack. 3)you were started on a medicine called lipitor for your cholesterol. please follow up as below. please call your doctor or return to the hospital if you have any concerning symptoms including fainting, chest pain, difficulty breathing or any other concerning symptoms. followup instructions: you have an appointment scheduled to follow up with dr. on at 11:15. please call if you need to reschedule this appointment. you also have an appointment to follow-up with dr. in orthopedic clinic on thursday at 8:40am on the of the clinical center on the of . if you need to cancel or reschedule this appointment, please call his office at . procedure: insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: subendocardial infarction, initial episode of care anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified unspecified fall rheumatoid arthritis dehydration diastolic heart failure, unspecified unspecified fracture of ankle, closed 

Answer: The patient is high likely exposed to