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: thrombolysis history of present illness: 68 y/o with severe cad with acute onset of chest pain and sob. pt report that since monday he has been holding his asa and plavix in preparation for an upcoming hernia repair. on monday he had a mild episode of cp / sob and briefly resumed asa / plavix. last evening at 730 he became fatigued. he awoke at 3am with sob (pnd) and chest pain described as substernal presure. it improved with 2 sl ntg and he reported to sleep. he again awoke at 7am with sob. while he was preparing to go to the ed, he developed non-radiating substernal pressure and severe sob. also had a pleuritic aspect to the pain. he was profoundly diaphoretic. symptoms feel similar to previous cardiac pain. it was minimally responsive to sl ntg at that time. the patient had been holding his blood thinners because of an upcoming procedure. . on arrival to the ed vs 96.5, 115/89, hr 60s-70s, 20, 98% 3l. shortly after arrival he became hypotensive to 81/51 but was fluid responsive. cta chest relieved a saddle pe and heparin gtt was started. recieved 3 l ivf. received zofran 4mg iv and morphine 2mg iv x 1. past medical history: # cad s/p multiple pcis: details below # diastolic chf: ef 55% on echo # hypertension # diabetes # hyperlipidemia # hypothyroidism # gerd # nash # appendectomy # chronic back pain # ed # acoustic neuroma # s/p appy . cardiac risk factors: diabetes, dyslipidemia, hypertension . percutaneous coronary interventions: -- : anatomy unknown -- : successful poba and direct bare metal stenting of the rca. -- : one vessel coronary artery disease (known 2 vessel cad with lca not injected). ptca of the instent occlusion of the distal rca. -- : poba of the rca and successful stenting of the ramus. -- : stenting of the distal avg lcx. stenting of the om2-3 origin disease. stenting of the proximal ri disease. all were drug eluting stents. -- : ptca and stenting of the avg lcx (with a 2.5x15 mm xience des) and proximal ri (with 3.0x16 mm taxus des). -- : 50-60% mid lad, 80% distal lad; 90% stent restenosis at origin om1; 40-50% distally; 90% restenosis of om2. poba with cutting and kissing balloon. social history: spanish speaking only. originally from . married, lives with wife and daughter. currently retired. smoking: he has never smoked. alcohol: no alcohol in the last two years, though did drink heavily in the past. drugs: he denies any illegal substance use. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death. family history otherwise non-contributory. father died of an mi at age 83. mother died of an mi at age 78. physical exam: admission physical exam gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. no pass-pointing on finger to nose. 2+dtr's-patellar and biceps pertinent results: . echo the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is moderately dilated with severe global free wall hypokinesis. there is appearance of rv apical sparing ( sign), worrisome for acute pulmonary hypertension from pulmonary embolism. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: dilated and hypokinetic right ventricle, c/w acute pulmonary hypertension. small, underfilled left ventricle with normal global and regional systolic function. compared with the prior study (images reviewed) of , rv systolic dysfunction is new. findings discussed with dr. at 0950 hours on the day of the study. . cta chest impression: 1. saddle embolus involving the bifurcation of the main pulmonary artery and with extensive clot burden in the left lung, specifically involving the left lower lobe segmental and subsegmental arteries. extensive thrombus is also present in the ascending and descending portions of the right pulmonary artery. scattered bilateral segmental and subsegmental thrombi are present. 2. evidence of right heart strain with enlargement of the right ventricle and loss of the normal right convex configuration of the interventricular septum. 3. no evidence of pulmonary infarction. . lenis impression: no evidence of deep venous thrombosis. . cxr -portable ap chest radiograph was reviewed in comparison to and 5 chest radiograph. heart size is normal. mediastinal position, contour and width are unremarkable. lungs are clear. no new consolidations to suggest interval development of infection or pulmonary infarct has been demonstrated. no pneumothorax is seen. . ekg sinus rhythm. non-specific intraventricular conduction delay. non-specific t wave flattening in the precordial leads. rsr' pattern in lead v1. compared to tracing #3 t wave flattening is new. . mrsa screen mrsa screen-final inpatient blood culture blood culture, routine-final emergency blood culture blood culture, routine-final emergency . hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 07:10 4.3 4.20* 11.8* 36.4* 87 28.1 32.4 16.1* 150 07:15 5.1 4.27* 12.2* 35.4* 83 28.5 34.4 16.1* 142* 07:30 6.3 4.67 13.1* 39.6* 85 28.1 33.2 16.2* 170 04:51 3.9* 4.30* 12.0* 36.1* 84 27.8 33.2 16.2* 110* 17:17 35.0* 05:54 5.9 4.23* 12.2* 36.0* 85 28.8 33.8 16.3* 130* 21:38 4.6 4.14* 11.7* 35.3* 85 28.2 33.1 16.2* 125* source: line-piv 04:53 4.8 3.99* 11.5* 33.9* 85 28.8 33.9 16.3* 124* 16:02 5.3 4.02* 11.6* 34.1* 85 28.8 34.0 16.3* 113* 08:20 7.3 4.31* 12.2* 36.3* 84 28.3 33.6 16.0* 169 differential neuts bands lymphs monos eos baso atyps metas 08:20 39.7* 54.3* 3.6 1.4 0.9 basic coagulation (pt, ptt, plt, inr) pt ptt plt ct inr(pt) 07:10 150 07:10 27.0* 31.7 2.6* 07:15 142* 07:15 17.2* 27.4 1.5* 12:15 14.3* 27.4 1.2* 07:30 170 04:51 110* 04:51 13.1 72.7* 1.1 23:04 72.0* heparin dose: 1500 17:17 75.2* heparin dose: 1500 09:24 48.0* heparin dose: 1350 05:54 130* 05:54 13.5* 36.7* 1.2* 02:10 38.8* source: line-piv l hand 21:38 125* source: line-piv 21:38 12.6 55.5* 1.1 source: line-piv 04:53 124* 04:53 79.9* 21:16 99.6* 16:02 113* 16:02 13.1 113.5*1 1.1 08:20 169 08:20 12.3 20.4*2 1.0 notified 510p verified by replicate analysis basic coagulation (fibrinogen, dd, tt, reptilase, bt) fibrino 05:54 148* 02:10 159 source: line-piv l hand inhibitors & anticoagulants heparin 02:10 <0.11 source: line-piv l hand <0.1 verified by replicate analysis lab use only 07:10 chemistry renal & glucose glucose urean creat na k cl hco3 angap 07:10 183*1 16 1.0 140 4.5 105 26 14 lft added @ 13:40 07:15 175*1 12 0.8 137 4.2 104 24 13 07:30 141*1 13 0.9 138 3.8 103 25 14 04:51 227*1 11 0.9 138 3.9 104 23 15 05:54 128*1 12 0.8 139 3.6 106 21* 16 21:38 201*1 source: line-piv 04:53 140*1 13 0.5 140 3.9 108 24 12 08:20 274*1 15 0.9 139 3.7 108 18* 17 bnp added 12:39pm if fasting, 70-100 normal, >125 provisional diabetes estimated gfr (mdrd calculation) estgfr 08:20 using this1 bnp added 12:39pm using this patient's age, gender, and serum creatinine value of 0.9, estimated gfr = >75 if non african-american (ml/min/1.73 m2) estimated gfr = >75 if african-american (ml/min/1.73 m2) for comparison, mean gfr for age group 60-69 is 85 (ml/min/1.73 m2) gfr<60 = chronic kidney disease, gfr<15 = kidney failure enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 07:10 pnd pnd pnd pnd lft added @ 13:40 07:15 77* 47* 95 0.4 07:30 90* 51* 330* 04:51 84* 39 270* 89 0.5 05:54 1351 15:20 1732 moderately hemolyzed specimen 04:53 1451 23:28 1581 21:00 1691 16:02 1561 new reference interval as of ;upper limit (97.5th %ile) varies with ancestry and gender (male/female);whites 322/201 blacks 801/414 asians 641/313 hemolysis falsely elevates ck. new reference interval as of ;upper limit (97.5th %ile) varies with ancestry and gender (male/female);whites 322/201 blacks 801/414 asians 641/313 cpk isoenzymes ck-mb ctropnt probnp 05:54 3 0.04*1 565*2 15:20 5 0.03*1 1230*2 moderately hemolyzed specimen 04:53 6 0.05*1 23:28 7 0.07*1 1406*2 21:00 7 0.08*1 16:02 6 0.12*3 08:20 <0.014 light green 08:20 112 bnp added 12:39pm ctropnt > 0.10 ng/ml suggests acute mi reference values vary with age, sex, and renal function;at 35% prevalence, ntprobnp values; < 450 have 99% neg pred value; >1000 have 78% pos pred value;see online lab manual for more detailed information notified at 0526 ctropnt > 0.10 ng/ml suggests acute mi <0.01 ctropnt > 0.10 ng/ml suggests acute mi chemistry totprot albumin globuln calcium phos mg uricacd iron 07:10 9.4 3.9 2.0 lft added @ 13:40 07:15 9.2 3.7 1.9 07:30 9.8 3.3 2.1 04:51 9.3 3.4 1.9 05:54 9.1 3.1 1.9 04:53 8.7 3.1 1.9 lab use only greenhd 23:28 hold1 hold discard greater than 4 hours old blood gas blood gases type temp rates tidal v peep fio2 o2 flow po2 comment 08:26 green top whole blood, miscellaneous chemistry lactate 16:09 2.7* 08:26 5.1*1 mri spine (): status post left-sided l4-5 laminectomy. no evidence of disc protrusion or nerve root compression, but the left l4 and l5 nerve roots are surrounded by postoperative scar. there is hyperintensity in the l4-5 disc on the long tr images, but no enhancement of the disc after contrast administration. this most likely reflects surgical changes, with infection far less likely given the lack of disc enhancement. brief hospital course: #acute pe: convincing explanation for acute sob and ce. radiographic evidence of a saddle embolus. echocradiogram with rv hypokinesis; however, patient remained hemodynamically stable. the patient's lenis showed no evidence of dvt. the patient was started on an anticoagulation regimen with a heparin gtt. after a day in the icu, the patient began to expeience new onset substernal pain/pressure. after contacting his cardiologist, dr. and conferring with his colleague, dr. , the patient was started on tpa, which he handled without any neurological complications. following administration of tpa, the patient's chest pain/pressure resolved. the patient was then placed on lovenox anticoagulation therapy with coumadin. pt remained hemodynamically stable after discharge from icu. he is likely going to require at least 6 months of anticoagulation. pt will also need to ensure age appropriate cancer screening and hypercoagulation work up in the outpatient setting. repeat echo can be considered in the outpatient setting. . #h.o severe cad s/p pci-now off plavix per patient's cardiologist dr. . pt on asa, bb, statin, . pt taken off plavix for now given current anticoagulation. he should f/u with dr. as outpt after dc. . #dm 2 controlled. dm diet, fs qid, hiss while in house with 75/25 insulin. he can resume metformin after discharge. . #chronic diastolic chf, but acute r.heart strain due to pe. pt continued on bb/asa as above. was restarted on and lasix restarted????? . #hypertension: patient was restarted on many of his home medications after several days in the icu in which his blood pressure first stabilized, then began to rise. no new antihypertensive agents were added. lasix????? bb, continued. . #cough-cxr without infiltrate or failure. no leukocytosis or other signs of overt heart failure. improved. pt given incentive spirometer and benzonatate. . #back pain-pt reported sharp back pain similiar to chronic pain which he has experienced since his back surgery. pt typically in l.buttock now in r.buttock. pt without neurologic deficits. he was given increased oxycodone 5-10mg q4 prn pain, tylenol prn, heat/ice packs prn, added lidocaine patch. his pain did not appropriately respond, and so pain service was consulted. they initially tried neurontin, but this caused nausea, and then tried pregabalin 50 mg qhs, which reduced his pain. we tried to increase to pregabalin 50 mg , but this resulted in some dizziness. ultimately, his pain regimen is oxycontin 10 mg po bid, pregabalin 50 mg po qhs, valium prn, lidoderm patch, tylenol, and oxycodone 5-10 mg po q4h prn. mri of spine was done with no acute process including bleed, mass, or infection; known post-surgical changes on left were seen. pt evaluated him and thought he was safe for discharge home with services. . #mild transaminitis-pt with h.o nash. on statin. has been mildly elevated in the past. trended downward to normal. continue statin given h.o severe cad. -trend and monitor lfts. will dc statin if continues to rise. could be somewhat congestive given r.heart strain from pe. . #thrombocytopenia/anemia. t.penia resolved this am. pt on coumadin. hit ab checked in icu and negative. pt with mild normocytic anemia. is on anticoag but did not display signs of active bleeding. hct 36 and platelets 214 on discharge. . #hypothyroidism-continued home levothyroxine. . fen:dm, cardiac diet . dvt ppx:coumadin/lovenox . gerd: continued home h2 blocker. medications on admission: asa 325mg qd plavix 75mg qd diovan 80mg qd metoprolol succinate 200mg qd furosemide 20mg 1.5 tablets qd ntg sl prn metformin 850 levothyroxin 100mg qd insulin discharge disposition: home with service facility: vna discharge diagnosis: acute pulmonary embolism acute musculoskeletal back pain . cad diastolic heart failure dm2 hypothyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with chest pain and shortness of breath and found to have a large blood clot in your lungs. you were initially admitted to the icu. for this, you were given a blood thinning medication with good effect. then, you were started on additional blood thinning medication-lovenox and coumadin. . you had a flare of your back pain while you were here. you were given pain medication and xray shows only degenerative changes. this was followed up by an mri of your spine, which showed some known surgical changes on the right side, and degenerative changes, but no acute infection or bleed. . you should make sure that you have routine health screening for your age such as colonoscopy. . medication changes: 1.coumadin, to be continued for at least 6 months 2.stool softeners 3.pain medications: lidoderm patch, oxycontin, lyrica, tylenol, oxycodone as needed, and valium as needed . please take all of your medications as prescribed and follow up with the appointments below. weigh yourself every morning, md if weight goes up more than 3 lbs. your discharge weight is 82 kgs (180.5 lbs). followup instructions: department: when: friday at 10:10 am with: , md building: campus: east best parking: garage department: pain management center when: monday at 3:10 pm with: , md building: one place (, ma) campus: off campus best parking: parking on site note: this was the first available appt they had but you have been placed on the cancellation list. if anything sooner becomes available, the office will call you directly. procedure: injection or infusion of thrombolytic agent diagnoses: thrombocytopenia, unspecified other chronic pain anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism percutaneous transluminal coronary angioplasty status pulmonary collapse other and unspecified hyperlipidemia other shock without mention of trauma long-term (current) use of insulin long-term (current) use of anticoagulants other constipation other acute pain other pulmonary embolism and infarction chronic diastolic heart failure lumbosacral spondylosis without myelopathy hemorrhage, unspecified other chronic nonalcoholic liver disease heart disease, unspecified impotence of organic origin hernia of unspecified site without mention of obstruction or gangrene 

Answer: The patient is high likely exposed to