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: cephalexin attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterizaton with balloon angioplasty to om2 history of present illness: the pt is an 86-y/o m with a pmh of cad s/p cabg, s/p pci to lcx (), s/p bioprosthetic aortic valve replacement, systolic chf s/p icd revision , now presenting with chest pain. the patient presented to this am with complaints of one hour duration, mid-sternal chest pain with band-like, cramping quality. pain in severity. his pain was intermittent and non-radiating. denies associated symptoms of jam, arm or back pain. no n/v, no diaphoresis. no precipitating factors. no dyspnea. vitals t 97.7, hr 61, bp 127/68, rr 16, o2 95%. he was started on nitroglycerin gtt 28mcg/min, pain improved to and gtt was increased to 56mcg/min with eventual improvement in pain to 0.5/10. he was also given aspirin 325mg, morphine 2mg iv and dilaudid 0.5mg iv x1. the patient is now transferred to for consideration of cardiac cath. . on arrival to the ccu, the patient is chest pain free. denies dyspnea. vitals: t 97.9, hr 61, bp 142/74, rr 10, o2 97% 2l past medical history: cad ' pci lcx stent ' cabg/avr systolic heart failure paf htn s/p appendectomy social history: widowed, lives alone. his son lives nearby and able to assist. -etoh -tob family history: noncontributory physical exam: physical examination: vs - vitals: t 97.9, hr 61, bp 142/74, rr 10, o2 97% 2l gen: wdwn elderly male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp elevated to earlobe cv: rrr, normal s1, s2. ii/vi sem loudest at llsb. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. + crackles r base with dullness on percussion, lll clear abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ dp 2+ pt 1+ left: carotid 2+ femoral 2+ dp 2+ pt 1+ pertinent results: 05:04pm blood wbc-11.2* rbc-4.67 hgb-14.3 hct-41.6 mcv-89 mch-30.6 mchc-34.4 rdw-14.7 plt ct-202 05:04pm blood neuts-79.4* lymphs-13.0* monos-6.8 eos-0.6 baso-0.2 05:04pm blood pt-42.0* ptt-34.6 inr(pt)-4.6* 05:04pm blood glucose-116* urean-38* creat-1.4* na-139 k-4.2 cl-99 hco3-30 angap-14 05:04pm blood ck(cpk)-106 05:55am blood alt-16 ast-22 ld(ldh)-226 ck(cpk)-25* alkphos-59 totbili-0.5 05:04pm blood ck-mb-5 ctropnt-0.02* 12:27am blood ck-mb-notdone ctropnt-<0.01 06:25am blood ck-mb-notdone ctropnt-<0.01 06:58pm blood ck-mb-notdone ctropnt-<0.01 05:04pm blood calcium-9.1 phos-3.5 mg-2.3 05:55am blood calcium-8.8 phos-2.7 mg-2.0 cholest-265* 05:55am blood triglyc-196* hdl-44 chol/hd-6.0 ldlcalc-182* . chest x-ray - - findings: as compared to the previous radiograph, the size of the cardiac silhouette is unchanged. also unchanged are the relatively low lung volumes. there is no evidence of focal parenchymal opacity suggestive of pneumonia, no pneumothorax, and no signs indicative of overhydration. minimal blunting of the costophrenic sinuses suggests minimal pre-existing pleural effusions. the pacemaker leads are in unchanged position. . - echo: - the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is 10-20mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated with moderate to severe global hypokinesis (lvef = 25 %). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. a well-seated bioprosthetic aortic valve prosthesis is present with normal gradient. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is at least mild pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: mild symmetric left ventricular hypertrophy with dilated cavity and global hypokinesis. normal aorticc valve bioprosthetic gradient with mild aortic regurgitation. mild-moderate mitral regurgitation. at least mild pulmonary artery systolic hypertension. . ekg - atrial and ventricular pacing. compared to the previous tracing there is no significant change. . cardiac catherization - comments: 1. coronary angiography in this right-dominant system revealed: --the lmca had no angiographically apparent disease. --the lad was totally occluded after d1. --the lcx had diffuse distal disease 50-60%, unchanged from before. the om and lcx stents were patent. om2 had a jailed origin 80% stenosis. --the rca was known occluded and not injected. 2. venous conduit angiography revealed the svg-om graft occluded at its origin. the svg-lad graft was patent. 3. limited resting hemodynamics revealed mild systemic arterial systolic hypertension, with sbp 149 mmhg. 4. successful ptca of the om2 origin using a 2.5x12mm quantum maverick balloon. final angiography showed normal flow, no apparent dissection, and a less than 20% residual stenosis. (see ptca comments.) 5. the right femoral arteriotomy was successfully closed using a mynx device. final diagnosis: 1. three vessel coronary artery disease. 2. patent svg-lad graft, occluded svg-om graft. 2. mild systemic arterial systolic hypertension. 3. ptca of the om2 origin was performed. brief hospital course: 86-y/o m with a pmh of cad s/p cabg, s/p pci to lcx (), s/p bioprosthetic aortic valve replacement, systolic chf s/p biventricular icd who presented with stuttering chest pain that resolved. cardiac enzymes were negative. patient underwent cardiac catherization and had stent placed in the om1. . #. chest pain - the pt has a significant history of cad with previous cabg and pci to lcx and om in . the pt presented with 1 hour history of mid-sternal, band-like chest pain not relieved by ntg. no associated symptoms, no clear precipitating event. cardiac enzymes were negative x3. no clear ecg changes however the pt is paced with lbbb morphology on ecg. presentation concerning for unstable angina given long cardiac history but notably with absense of ecg and ce changes. patient was admitted for cardiac catherization which was delayed secondary to elevated inr. once inr was < 1.8 patient was taken to cardiac catherization which demonstrated cath obstructed om1 which was balooned as well as distal lad and rca complete obstructions that were not intervened upon. patient was started on iv heparin drip and nitro drips. iv heparin was discontinued after the patient had 3 sets of negative enzymes. patient was continued on beta blocker, aspirin. initially prior to cardiac catherization patient was placed on plavix 75 mg po daily however this medication was discontinued prior to discharge. cardiac catherization demonstrated three vessel coronary artery disease, patent svg-lad graft, occluded svg-om graft, mild systemic arterial systolic hypertension. patient had ptca of the om2 origin was performed. as patient with extensive coronary artery history and also with markedly elevated ldl patient was started on statin. given that already on amiodarone as outpatient started atorvastatin 20 mg po daily. . #. systolic heart failure - pt with report of severe chf, biv icd placed . ef on exam patient appeared euvolemic. echo showed ef 25%, mild symmetric left ventricular hypertrophy with dilated cavity, global hypokinesis; nml as valve with mild ar, mild mr, mild . patient was continued on home regimen on bb, spironolactone and lasix 60 mg daily. patient also on aspirin and as above was started on statin. patient with severe systolic heart failure but not previously on ace inhibitor so will defer starting to outpatient cardiologist given recent cardiac catherization and dye load. . #. hx of nsvt s/p icd - continue outpatient regimen of amiodarone 100mg po daily and metoprolol. . #. paf - patient maintained on amiodarone and metoprolol which were continued on admission. patient on coumadin as an outpatient. inr elevated on admission likely secondary to recent levoquin use. initially coumadin was held in preparation for cardiac catherization and restarted on discharge. . #. gout - completed prednisone taper for gout flare. patient complained after completion of prednisone taper that his toe was bothering him again. toe base appeared red and inflammed. patient reports that he has never had toe tapped to look for crystals and has not been on prophylactic medications such as allopurinol or colchicine. given acute nature of worsening symptoms started patient on short course of colchicine to complete 3 day course. patient told to follow up as outpatient with primary care doctor and to have toe tapped and begin appropriate therapy. . #. hx of recent pna - resolved. pt recently completed six day course of levaquin/flagyl for post-procedure pna , currently with decreased r sided breath sounds and wheezes. the floroquinolone likely caused the suprathrapeutic inr. cxr this admission with no evidence of pna and wbc are wnl. . #. fen - cardiac diet, fluid restrict 2l daily . #. access: piv . #. ppx: coumadin, bowel regimen . #. code: full medications on admission: amiodarone 100 mg tablet daily furosemide 40 mg tablet daily metoprolol succinate 25 mg po daily nitroglycerin 0.4 mg tablet prn spironolactone 25 mg tablet po daily warfarin 2 mg tablet daily aspirin 81 mg tablet 1 tablet daily prednisone 40mg daily x 5days - 3days remaining discharge medications: 1. amiodarone 200 mg tablet sig: 0.5 tablet po daily (daily). 2. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 3. furosemide 40 mg tablet sig: 1.5 tablets po once a day. disp:*45 tablet(s)* refills:*2* 4. nitrostat 0.4 mg tablet, sublingual sig: one (1) tablet sublingual every 5 minutes for total 3 doses: if you still have chest pain after 3 doses, call 911. 5. warfarin 2 mg tablet sig: one (1) tablet po once a day. 6. outpatient lab work please check inr on monday , call results to dr. 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. colchicine 0.6 mg tablet sig: one (1) tablet po once a day for 5 days. disp:*5 tablet(s)* refills:*0* 9. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. discharge disposition: home discharge diagnosis: chronic systolic congestive heart failure coronary artery disease acute gout flare discharge condition: stable. discharge instructions: you had chest pain that caused you to go to , then you were transferred here. you did not have evidence of damage to your heart muscle (heart attack). you pacemaker was evaluated and you did not have evidence of any irregular rhythms that could cause the chest pain. you had a cardiac catheterization that showed a blockage in one of the small arteries near your heart. this was opened with a balloon but no stent was placed. you had a gout flare after the prednisone was stopped, colchicine was given to treat the pain and inflammation. new medicines: 2. metoprolol: to slow the heart rate and help your heart pump better 3. atorvastatin: to keep your chelesterol low and prevent further blockages . weigh yourself every morning, md if weight > 3 lbs in 1 day or 6 pounds in 3 days. adhere to 2 gm sodium diet . please call dr. if you have any further chest pain, nausea, trouble breathing, cough or any other unusual symptoms. . no pools or baths for one week, you may shower and cover the groin site with a band-aid. no lifting more than 10 pounds for one week. please talk to dr. about an exercise program or cardiac rehabilitation. . please resume your coumadin at your previous dosing and check inr on monday followup instructions: cardiology: provider: phone: date/time: 10:00 primary care: , md phone: date/time: monday at 2pm. procedure: coronary arteriography using two catheters left heart cardiac catheterization other and unspecified coronary arteriography insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent automatic implantable cardioverter/defibrillator (aicd) check excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome congestive heart failure, unspecified gout, unspecified atrial fibrillation aortocoronary bypass status old myocardial infarction chronic systolic heart failure automatic implantable cardiac defibrillator in situ cardiac pacemaker in situ heart valve replaced by transplant 

Answer: The patient is high likely exposed to