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: lipitor / yellow dye attending: chief complaint: chest pain; transfer from sturdy er to er major surgical or invasive procedure: cardiac catheterization s/p bms to rca history of present illness: dr. is a 60 year old woman with history of diabetes who presented to osh (sturdy er) with chest pain. on day prior to transfer () she was sitting at work and became diaphoretic. then she had onset of chest discomfort. upon standing, she felt lightheaded. she layed down and over the next 2-3 minutes, she had increasing chest discomfort with radiation to l arm and jaw, increasing to pain. she took aspirin and called 911. she went to osh and initially had no st elevations. she was given nitro with no improvement. they gave her aspirin, plavix 300mg, and heparin and transferred her here for story concerning story for unstable angina. in the ed at , initial vs were t98.6 p50 bp 110/p 100% on nrb. she had inferior st elevations and reciprocal depressions anteriorly, elevations in v1. she complained of cp in ed, vitals remained stable. she was given heparin, morphine, integrillin and an additional 300mg plavix to complete load. she was taken to cath lab where she was found to have proximal occlusion of rca which appears like chronically diseased vessel that thrombosed. bms placed and she had some reperfusion rhythm but remained hemodynamically stable on integrillin. . on the floor overnight she was hypotensive with systolic pressures in 70s. she received 5-6l ivf. she continued to complain of chest pain radiating to left arm as well as nausea and dyspnea. she complained of feeling lightheaded and dizzy. her ecgs showed intermittent junctional rhythm and sinus bradycardia. upon transfer to the icu her vs: hr 54 bp 77/40 02 89-96% on 3l. she was vomiting. she received 0.5mg atropine x 2 without effect and was started on dopamine. past medical history: cardiac risk factors: (+) diabetes, dyslipidemia, hypertension . cardiac history: cabg: none percutaneous coronary intervention: none pacemaker/icd: none . other past history: # diabetes mellitus type ii x 4 years - on januvia and metformin in past; currently diet-controlled with juice-plus; # partial lipodystrophy; congenital/mitochondrial myopathy - when symptomatic (weak legs), avoids fatty foods - has had steroid treatment in past # s/p right hand injury w/ surgical repair # s/p fractured l shoulder s/p surgery # s/p uteropexy x2 # s/p sexual assualt on arv prophylaxis social history: smoke: cigarettes /day x 40 years; states she will quit after today. etoh: <1 drinks per week. illicits: remote mj; tried cocaine once in past; never ivdu lives/works: she is a neuroendocrinologist. single, sexually active with men and women. recently sexually assaulted on . family history: there is no family history of premature coronary artery disease or sudden death. biological mother: ppd/? bipolar. deceased in her 60s biological father: mitochondrial dystrophy, lymphoma, depression. deceased in his 60s brother with myopathy, alive and well other: adopted as infant physical exam: vs: 56 76/45 20 93% 3l gen: middle aged woman, in distress, vomiting. heent: ncat. sclera anicteric. eomi. conjunctiva were pink, oral mucosa mildly cyanotic neck: supple, jvp to angle of jaw. cv: pmi located in 5th intercostal space, midclavicular line. bradycardic. normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. chest: due to position in trendelenberg only assessed lateral lung fields. mild coarse rhonchi. abd: soft, ntnd. no hsm or tenderness. no abdominial bruits. ext: extremities cool. 1+ dp pulses bilaterally. r sided cath incision c/d/i, no bruits, non-tender, no hematoma. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: admission labs: 03:10pm blood wbc-10.8 rbc-4.17* hgb-13.3 hct-37.1 mcv-89 mch-31.8 mchc-35.8* rdw-13.4 plt ct-362 03:10pm blood neuts-59.3 lymphs-33.6 monos-5.9 eos-0.9 baso-0.3 06:10pm blood pt-11.8 ptt-58.6* inr(pt)-1.0 03:10pm blood urean-16 creat-0.7 03:10pm blood alt-33 ast-26 alkphos-112* totbili-0.4 06:02am blood triglyc-351* hdl-19 chol/hd-6.5 ldlcalc-34 ldlmeas-60 . cardiac enzymes: 06:10pm blood ck-mb-3 06:10pm blood ctropnt-<0.01 06:10pm blood ck(cpk)-47 09:33pm blood ck-mb-57* mb indx-8.4* 09:33pm blood ck(cpk)-678* 06:02am blood ck-mb-51* mb indx-7.7* ctropnt-2.02* 06:02am blood ck(cpk)-660* 02:31am blood ck-mb-22* mb indx-4.4 ctropnt-1.03* 02:31am blood ck(cpk)-501* . discharge labs: 04:25am blood wbc-8.9 rbc-3.40* hgb-10.6* hct-31.0* mcv-91 mch-31.2 mchc-34.3 rdw-16.4* plt ct-283 04:25am blood glucose-168* urean-14 creat-0.4 na-137 k-3.7 cl-104 hco3-26 angap-11 04:25am blood calcium-8.3* phos-2.9 mg-1.7 . echo: the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is 0-10mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels 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 structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , regional biventricular systolic function is now normal. . echo: the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with focal basal inferior and inferolateral hypokinesis. the remaining segments contract normally (lvef = 45%). the estimated cardiac index is borderline low (2.0-2.5l/min/m2). the right ventricular cavity is mildly dilated with focal hypokinesis of the apical free wall. 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. an eccentric, posteriorly-directed jet of mild (1+) mitral regurgitation is seen, consistent with some leaflet tethering. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: mild regional biventricular systolic dysfunction, c/w inferoposterior and right ventricular ischemia/infarction. mild ischemic mitral regurgitation. elevated systemic venous pressures. . cath: comments: 1. coronary angiography in this right dominant system demonstrated total proximal occlusion of the rca. the lmca had minimal disease. the lad had moderate disease. the lcx had an eccentric 60% distal stenosis. 2. limited resting hemodynamics revaled systemic arterial normotension. 3. successful primary angioplasty of the proximal rca with stenting with a 2.5x23 mm mini vision bms with good results. 4. brief reperfusion arrhythmia (aivr) upon balloon inflation and re-establishment of antegrade flow without hemodynamic instability 5. multivessel residual disease (see ptca comments for details) was left to medical therapy. should symptoms recur or ischemia recurs, consider revascularization of the mid rca and teh lcx (especially the distal) lesions. 6. diffuse occlusive and likely aneurysmal peripheral arterial disease. consider non-invasive vascular ultrasounds (or cta) to evaluate for aortic and/or iliac aneurysm. final diagnosis: 1. stemi with total occlusion of proximal rca. 2. otherwise multivessel non-obstructive diffuse coronary disease. 3. sucecwssful ppci and stenting of teh ostial/proximal rac with a minivision bms. 4. dual antiplatelet therapy (asa and plavix x minimum of 12 months) and integrilin gtt (x18 hours) 5. global cardiovascular risk reduction including complete smoking cessation, target ldl <70, hdl >50, tg <150 and bp < 135/80 . cxr: normal chest radiograph. no evidence of pneumonia. . ekg:sinus rhythm with a-v conduction delay and occasional ventricular ectopy. compared to the previous tracing of sinus rhythm and occasional ventricular ectopy have appeared. brief hospital course: patient is a 60f presenting with chest pain, underwent cath which showed proximal rca occlusion with placement of bms. post-cath course s/b hypotension, bradycardia. . #. cad: patient had an inferior stemi and right ventricular mi and was taken to cardiac catheterization with placement of bms to proximal rca. her post-cath hospitalization was complicated by hypotension and bradycardia (see below), which was felt to be secondary to the nature of her mi. she was managed with anti-platelet therapy: asa 325 and plavix 75mg daily. the team discussed benefits of statin; however, patient continued to refuse statins given concern for exacerbation of mitochondrial myopathy. team asked her to continue red yeast rice which she was taking at home. she was started on lisinopril post-mi. patient was initially refusing metoprolol as she was concerned that it would exacerbate depression symptoms. ultimately, she agreed to try a small dose of metoprolol, which was started as an inpatient. . # hypotension/bradycardia: patient developed hypotension and bradycardia in the setting of rv mi. telemetry showed junctional rhythm. she was treated with atropine and started on dopamine. the dopamine was weaned off when blood pressure stabilized. an echocardiogram did not show effusions and her groin on exam was benign without evidence of hematoma. bradycardia and hypotension resolved within 48 to 72 hours post mi. she was gradually started on lisinopril and metoprolol as blood pressure and heart rate stabilized. further telemetry showed that patient was in sinus rhythm. . #. dm: diet controlled. used to be on januvia and metoformin. per ob/gyn note, hba1c 5.9, but not in our system. while patient was in hospital she was started on an iss. she was also started on low dose lisinopril. . # lipodystrophy/mitochondrial disease: stable. patient concerned that starting statin therapy would increase myalgias (see above). . # s/p sexual assault: patient is being followed closely by id who is following safety labs on arvs. she has been seen by psych and ob/gyn as well. her combivir, kaletra, effexor, and lorazepam were continued. she was seen by social work while inpatient. . #. patient has no health insurance. while inpatient, social work discussed with patient about applying for mass health. she was discharged with following with free care clinic at . medications on admission: medications: (home) januvia, metformin - recently discontinued iss - humalog (self started due to hyperglycemia from arvs) aspirin 325mg po daily effexor xr 150mg qday clonidine 0.1mg po bid for anxiety lamivudine-zidovudine - 150 mg-300 mg tablet lopinavir-ritonavir - 400 mg-100 mg tablet lorazepam 0.5mg qid: prn immodium robitussin diabetic . (transfer) acetaminophen albuterol aspirin 325mg daily benzonatate cefazolin x 2 doses clopiogrel 75mg daily heparin sc iss ipratropium combivir lorazapam prn kaletra morphine prn nicotine patch ondansetron prn dopamine eptifibatide venlafaxine discharge medications: 1. aspirin 325 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:*2* 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. lamivudine-zidovudine 150-300 mg tablet sig: one (1) tablet po bid (2 times a day). 4. lopinavir-ritonavir 200-50 mg tablet sig: one (1) tablet po bid (2 times a day). 5. venlafaxine 75 mg capsule, sust. release 24 hr sig: two (2) capsule, sust. release 24 hr po daily (daily). 6. loperamide 2 mg capsule sig: two (2) capsule po tid (3 times a day) as needed for diarrhea. 7. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 8. metoprolol succinate 25 mg tablet sustained release 24 hr sig: 0.5 tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 9. lorazepam 0.5 mg tablet sig: one (1) tablet po four times a day as needed for anxiety. discharge disposition: home discharge diagnosis: primary: inferior mi rv mi hypotension bradycardia discharge condition: a&ox3 self ambulating discharge instructions: you were admitted to because you had a heart attack. while you were here you underwent cardiac catheterization and had a bare metal stent placed to the right coronary artery. you were started on aspirin and plavix. it is very important that you take aspirin and plavix every day. these medications are blood thinners and will prevent further clots from forming. we would like to start you on statin therapy, such as lipitor. we have discussed the benefits of lipitor. however, you have refused to take this medication, and so we encourage you to continue taking your red yeast rice. we also encourage you to see a muscle doctor to discuss the risk of myopathy with statins. we have made the following changes to your medications: 1. start plavix 2. start aspirin 3. start metoprolol succinate 4. start lisinopril 5. stop clondine. please see your psychiatrist before restarting this. followup instructions: free care clinic at : at 4pm. please call financial services at to make sure the appropriate paperwork is done prior to your appointment. provider: , md phone: date/time: 8:30 provider: care id phone: date/time: 1:30 procedure: insertion of non-drug-eluting coronary artery stent(s) injection or infusion of platelet inhibitor left heart cardiac catheterization coronary arteriography using a single catheter 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 coronary atherosclerosis of native coronary artery tobacco use disorder diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other specified cardiac dysrhythmias acute myocardial infarction of inferoposterior wall, initial episode of care other specified hypotension chronic total occlusion of coronary artery disorders of mitochondrial metabolism congenital hereditary muscular dystrophy 

Answer: The patient is high likely exposed to