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: no known allergies / adverse drug reactions attending: chief complaint: chest pain major surgical or invasive procedure: -left heart catheterization with balloon angioplasty to the proximal and mid rpda artery -right heart catheterization to evaluate asd history of present illness: 83 yo m with hx of prior mi (), dmii, htn, dyslipidemia, gerd, depression, glaucoma presented to osh with complaints of chest pain since last night and bp elevated to 190/80 and transferred to for stemi. . patient was in usoh, pain described as intermittent with radiation to his left arm and jaw, associated with nausea but denies palpitations, shortness of breath, dizziness, vomitting. . osh course: first ekg and cardiac enzymes at osh was normal (415 am). however he continued to complain of chest pain. second set of enzymes showed elevated troponin to 0.15, ck-mb 22 and repeat ekg showed st elevation in inferior leads (12:15 pm). he was started on a nitroglycerin drip, heparin drip and received iv morphine, aspirin, lopressor 25mg po, and plavix 75mg po. he was then transfered to for emergent catheterization. . in the cath lab, he received heparin, fentanyl, ntg. cardiac surgery was consulted but touchdowns were unsuitable for cabg. poba to prox and mid rpda. had lvedp of 26, dx with severe lv diastolic heart failure. angioseal placed and sent on ntg drip to ccu. . at baseline, he reports being able to walk mile. he is limited by leg cramping, but denies any chest pain or shortness of breath. endorses 1 pillow orthopnea, denies pnd. . on review of systems, he endorses chest pain, leg cramping, orthopnea. he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. all of the other review of systems were negative. . cardiac review of systems is notable for presence of chest pain and orthopnea. notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors: +diabetes, +dyslipidemia, +hypertension 2. cardiac history: mi , cad - cabg: none - percutaneous coronary interventions: none - pacing/icd: none 3. other past medical history: - gerd - depression - glaucoma - pseudophakia - ectropion - l wrist fx social history: he was widowed in , lives alone, has no children. he is currently retired, formerly worked as a prison guard. has a who lives across the street. formerly independent adl's. - tobacco history: quit 10 years ago - etoh: beer on weekends - illicit drugs: denies family history: family history: - mother: died of mi at age 76 - father: died of emphysema at 71 - brother: stomach cancer physical exam: on admission vs: t=96.8 bp= 147/83 hr=89 rr=12 o2 sat= 99% general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. mmm neck: supple,no jvd cardiac: rrr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. no femoral bruits. no hematomas at cath site skin: intact. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . on discharge general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. mmm neck: supple,no jvd cardiac: rrr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. extremities: no c/c/e. no femoral bruits. no hematomas at cath site skin: intact. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ harge pertinent results: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:30 10.6 4.41* 13.9* 42.2 96 31.6 32.9 14.3 134* 07:30 11.7* 4.53* 14.2 43.0 95 31.3 33.0 14.3 146* 07:25 13.6* 4.25* 13.6* 41.1 97 31.9 33.0 14.3 137* 06:16 38.8* 155 21:04 16.0* 4.43* 14.3 42.0 95 32.4* 34.1 14.2 152 renal & glucose glucose urean creat na k cl hco3 angap 06:30 232*1 31* 1.4* 138 4.3 104 28 10 07:30 240*1 30* 1.5* 136 3.8 100 28 12 07:25 220*1 27* 1.4* 138 3.5 103 25 14 06:16 27* 1.4* 136 3.3 101 21:04 285*1 22* 1.3* 138 3.8 102 22 18 cpk isoenzymes ck-mb mb indx ctropnt 07:25 15* 6.8* 06:16 137* 21:04 155* 11.7* 3.31* diabetes monitoring %hba1c eag 21:03 6.7*1 146* chemistry calcium phos mg cholest 07:30 1.8 07:25 8.2* 1.8* 2.1 21:04 8.5 2.9 2.0 175 left heart catheterization (): 1. severe three vessel coronary artery disease. cardiac surgery consulted who did not fel anatomy suitable for cabg given severity of native vessels without adequate graft targets. 2. severe systemic hypertension. 3. severe left ventricular diastolic heart failure post-pci. 4. successful balloon angioplasty of the proximal and mid rpda. 5. successful rfa angioseal closure. 6. aspirin given at the conclusion of the case given vomiting of undetermined pill fragments. 7. consider clopidogrel re-load and 75 mg daily for at least 1 month for secondary prevention post-mi and post-pci, with assessment of benefits with respect to secondary prevention post-pci versus bleeding risks. dual anti-platelet therapy is not mandatory as stent was not deployed (due to small vessel size <2 mm reference vessel diameter and poor runoff). 8. follow up with dr. . . echo (): the left atrium is elongated. a left-to-right shunt across the interatrial septum is seen at rest. a secundum type atrial septal defect is present. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. lv systolic function appears globally depressed (ejection fraction 30-35 percent) with regional variation: the posterior wall is akinetic, the inferior and lateral walls are severely hypokinetic, and most of the other walls of the left ventricle are mildly hypokinetic. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the right ventricular free wall is hypertrophied. right ventricular chamber size is normal. with borderline normal free wall function. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . right heart catheterization (): 1. no significant left to right shunt. 2. moderate pulmonary hypertension. 3. elevated filling pressures. 4. preserved cardiac output. . brief hospital course: 83 yo m with hx of prior mi (), dmii, htn, dyslipidemia, who presented to osh with complaints of chest pain and elevated transferred to for an inferior stemi. pt was not a cabg candidate so he is s/p poba and medical management of his stemi. . active issues . # stemi: on presentation to , pt was taken to cardiac catheterization where he was found to have extensive three vessel disease which cardiac surgery deemed unsuitable for cabg due to the severity of disease in the native vasculature and the absence of adequate graft targets. pt underwent poba to the proximal and mid-rpda and was subsequently transferred to the ccu post-procedure for monitoring and medical management. pt had vomited all of his pills at the end of the case so in the ccu he was reloaded with plavix, to be continued for a one month course. he was also kept on a nitro drip, asa, lopressor, captopril, and started on atorvastatin. pt was soon stable enough to be transitioned to metoprolol xl and lisinopril 20 mg and was transferred to the cardiac floor. . # hypertension: pt's bps were very elevated to the 190s on admission and were elevated to the 160s-170s intermittently over the course of his hospital stay, requiring much titration of his blood pressure medications. likely etiology is progression of pt's severe long-standing hypertension. pt's bps were improved at discharge to the 140s on a regimen of metoprolol and lisinopril. . # fever: on , pt spiked a fever to 101.5, experienced 5 minutes of atrial tachycardia and his bps were elevated to 170s. pt denied any chest pain, sob, cough, or dysuria and cultures drawn at the time were still pending at the time of discharge. pt received 6.25mg captopril with improvement of his blood pressures and an ecg at the time showed no evidence of acute ischemia. pt remained afebrile and showed no signs of infection over the remainder of his hospital stay. . # acute diastolic chf: during his left heart cath, patient was noted to have severe left ventricular diastolic dysfunction with an lvedp of 26. patient was diuresed with 40mg iv lasix to good effect (net out 1.2l) in an effort to improve his volume status. in order to determine pt's baseline pump function, a prior echo was obtained from his outpt provider which showed left-to-right shunt across the interatrial septum. right heart catheterization was performed to evaluate the size of the shunt and to determine whether it was contributing to his diastolic dysfunction, but the shunt was not found to be hemodynamically significant. . chronic issues . #diabetes: stable. was controlled on insulin sliding scale during his admission and his home meds were re-started at discharge. . # depression: stable. continued celexa. . transitional issues pt was reloaded with plavix due to vomiting of medicine after the procedure, and it is recommended that pt be continued on it for a one month course. if pt's blood pressures remain elevated post-discharge, consider re-starting pt's home dose of imdur. medications on admission: - xalatan eye drops and dorzolamide eye drops - imdur 60mg po daily - lopressor 25 mg po bid - lovastatin 10 mg po daily - prilosec 20 mg po daily - precose 50 mg po qac - aspirin 81mg po daily - vitamin c 500 mg po daily - vitamin e 400 mg po daily - glipizide 5 mg po daily - celexa 20 mg po daily discharge medications: 1. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 3. dorzolamide 2 % drops sig: one (1) drop ophthalmic as directed. 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 7. ranitidine hcl 150 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 8. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). disp:*30 tablet extended release 24 hr(s)* refills:*2* 9. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. precose 50 mg tablet sig: one (1) tablet po before meals. 11. glipizide 5 mg tablet sig: one (1) tablet po once a day. 12. vitamin c 500 mg tablet sig: one (1) tablet po once a day. 13. outpatient lab work please check chem-7 on tuesday with results to dr., 14. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet sublingual as directed. disp:*25 tablets* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: non st elevation myocardial infarction acute systolic duysfunction: ef 35% diabetes type 2 hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you had a heart attack and needed a cardiac catheterization with a balloon angioplasty to open up 2 arteries on the right side. this procedure went well and you did not have any further chest pain. you will be sent home on some new medicines to help your heart recover from the heart attack and optimize your heart function. if you have chest pain at home, you can take a nitroglycerin tablet under your tongue to see if this help the chest pain. you can take 2 tablets 5 minutes apart. please call dr. if you have any chest pain at all at home. your heart is weaker after the heart attack and you will need to watch your legs for signs of swelling. you may also have trouble breathing or trouble lying flat to sleep. if you notive these things, please call dr. . weigh yourself every morning before breakfast, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. . we made the following changes to your medicines: 1. start taking plavix (clopidogrel) and full dose aspirin (325mg)every day to help your heart arteries stay open 2. stop taking omeprazole as it can interfere with the plavix, take ranitidine instead 3. change metoprolol to a long acting version (succinate) and increase the dose to 100 mg to help your heart recover from the heart attack 4. start taking lisinopril to lower your blood pressure and help your heart recover from the heart attack 5. discontinue lovastatin and take atorvastatin inestead, this is better for your heart to recover from the heart attack 6. stop taking vitamin e followup instructions: primary care: , m. his office is closed on friday so please call the office on to make an appt in the next 5 days. . cardiology: , hospital , tuesday at 3:00pm procedure: coronary arteriography using two catheters left heart cardiac catheterization right heart cardiac catheterization 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 other chronic pulmonary heart diseases personal history of tobacco use other and unspecified hyperlipidemia other specified cardiac dysrhythmias acute myocardial infarction of other inferior wall, initial episode of care old myocardial infarction fever, unspecified acute combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to