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: percocet attending: chief complaint: progressive doe major surgical or invasive procedure: cardiac catheterization x 2 stenting of svg to diagnol with cypher stent for 90% stenosis history of present illness: 66 year old man is s/p an mi at age 31 with subsequent five vessel cabg in (lima -> lad, svg -> rca, svg->d1->om2->om3), ischemic cardiomyopathy with an lvef of 25%, htn and as who presents with exertional dyspnea and chest discomfort. patient has significant h/o cad with multiple cardiac catheterizations through the years, most recently in while in . at the time he had noticed a recurrence of exertional dyspnea and chest discomfort. an echo reportedly had revealed aortic stenosis with a peak gradient of 52 mmhg with a valve area of 1.0cm2 and a pa systolic pressure of 61 mmhg. cardiac cath at that time revealed a patent lima and svg to the diagonal. the ostial diagonal graft had a tight stenosis that was treated with bare metal stenting. the jump graft to the om??????s and the svg to the rca were occluded. he reported resolution of his symptoms at that time. . since the patient has noted that his exertional dyspnea and chest discomfort have returned. symptoms have been progressive since then and are limiting him significantly. he reports that he becomes sob with limited exertion and can only walk block without stopping due to dyspnea. additionally, he has been getting exertional chest discomfort, non-radiating, relieved by imdur. he denies associated nausea or diaphoresis. he also reports worsening orthopnea but no le swelling. he was admitted to for cardiac cath which he underwent on . he was found to have an ostial occlusion of svg->d1, but he was not intervened upon because of critical as (0.88cm2) due to a question was whether he should have avr done at the same time. however, the patient requested to have the avr done at another time and to proceed with stenting of svg->d1 now. he returned to the cath lab on for pci where he had a cypher stent placed in the svg-d1. right heart cath revealed an elevated pcwp of 26. additionally, his aortic valve gradient was imaged with and without dobutamine and there was no change with dobutamine. . on arrival to the ccu the patient denied cp, sob, palpitations. he denied recent fever or chills. he denied nausea, vomiting, abdominal pain. he also denied recent dysuria or change in his bowel habits. past medical history: hypertension elevated triglycerides cad s/p cabg (lima -> lad, svg ->rca, svg->d1->om2->om3) mi- age 35 ischemic cardiomyopathy with an ef 25% on tte s/p icd for a cardiac arrest (dddr ) aortic stenosis, valve area 0.88cm2 cri bph right knee replacement gerd/hiatal hernia thrombocytopenia of unclear etiology social history: social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. patient is married with adult children. family history: family history is significant for mother with prior mi??????s. she died in her 80??????s from heart disease. two brothers??????s had cabg in their late 50??????s or 60??????s; sister had cabg in her 60??????s. physical exam: ccu admit note: vs: t 99.5 bp 147/80 p 58 rr 15 97% on 2l gen: lying comfortably in bed, 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 without jvp. rij catheter in place. no carotid bruits cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. iii/vi sem heard best rusb. chest: well-healed sternotomy scar. resp were unlabored, no accessory muscle use. cta anteriorly, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. r groin without hematoma, l groin with sheath in place, no hematoma skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ left: carotid 2+ femoral 2+ popliteal 2+ dp 1+ pt 1+ pertinent results: last cath at osh was as follows: - lad with proximal occlusion - lcx diffusely diseased with multiple collaterals - rca with ostial occlusion - svg to rca is occluded - svg from aorta to d1 is known to be occluded in the sequential segment from the diag to the oms. (95% ostial) --> stented (bare metal) - lima-> lad is patent - moderate as with valve area of 1.3cm2 - elevated lvedp - lvef noted at 20-25% . echo: lv dilated with concentric lvh and markedly decreased contractility. diffuse hypokinesis noted of the anterior apical and lateral walls with akinesis of the inferior wall. ef estimated at 25%. at 5.0cm. aortic valve calcified with a peak gradient of 37 mmhg, mean of 21 mmhg and a valve area of 0.98cm2. there was trace ai, mild to moderate mr and moderate tr with a calculated pa systolic pressure of 62 mmhg. (prior echo from revealing aortic valve area of 1.3cm2) . cardiac cath: comments: 1. selective coronary angiography of this right dominant system demonstrated multivessel severe cad. the lmca had 60% distal stenosis. the lad was occluded proximally and diffusely diseased in the mid and distal segments. the lcx was diffusely disease with total occlusion of its om1 branch. the rca was occluded. 2. arterial conduit angiography revealed occluded svg to pda and occluded sequential om1-om2 vein graft. the svg-diag had 90% ostial stenosis (in-stent-restenosis). the lima-lad was patent. 3. resting hemodynamic assessment revealed severely elevated left and right heart filling pressures with mean pcwp of 41 mmhg and lvedp of 36 mmhg. pulmonary arterial pressure was severealy elevated (72/36 mmhg). systemic arterial blood pressure was mildly elevated (146/70 mmhg). 4. severe aortic stenosis was evident with mean gradient across the aortic valve of 27 mmhg and calculated aortic valve area of 0.88 cm2. 5. left ventriculography revealed severely impaired systolic and diastolic funstion with calculated lvef 25% and lvedp 36 mmhg. the lv was globally hypokinetic. mild mitral regurgitation was noted. final diagnosis: 1. three vessel coronary artery disease with 90% in-stent-restenosis at ostium of svg-diag. 2. severe aortic stenosis. 3. mild mitral regurgitation. 4. severe systolic ventricular dysfunction. 5. severe diastolic ventricular dysfunction. 6. severe primary pulmonary hypertension. . cardiac cath: comments: 1. the svg lesion was stented with a 3.5 mm cypher stent and posted with a 4.0 mm balloon with an excellent result. (see ptca comments) 2. the gradient across the aortic valve was measured with dobutamine infusion with increasing doses. the gradients prior to and at the peak of the infusion are 21.79 mm and a21.45 mm hg resepectively. the for the same calculation were 1.03 cm2 and 1.08 cm2 respectively. 3. the single plane cine ventriculogrphy showed severe systolic and diastolic dysfunction with a calculated ef of 26%. final diagnosis: 1. three vessel coronary artery disease. 2. severely compromised ventricular function. 3. mild to moderate as 4. successful stenting of the svg. labs: 12:40pm blood wbc-6.3 rbc-3.25* hgb-9.4* hct-27.6* mcv-85 mch-28.9 mchc-33.9 rdw-17.3* plt ct-91* 07:20am blood wbc-6.3 rbc-3.74* hgb-10.7* hct-31.7* mcv-85 mch-28.7 mchc-33.8 rdw-17.8* plt ct-90* 12:40pm blood pt-15.7* inr(pt)-1.4* 07:20am blood pt-14.2* ptt-36.0* inr(pt)-1.3* 05:34pm blood ret aut-2.1 12:40pm blood glucose-104 urean-31* creat-1.5* na-145 k-4.1 cl-110* hco3-27 angap-12 07:20am blood glucose-97 urean-25* creat-1.4* na-141 k-3.9 cl-104 hco3-29 angap-12 05:34pm blood alt-20 ast-20 ck(cpk)-39 alkphos-60 amylase-52 totbili-0.9 dirbili-0.3 indbili-0.6 05:34pm blood albumin-3.7 calcium-8.0* iron-71 cholest-92 07:20am blood mg-2.3 05:34pm blood caltibc-351 vitb12-527 folate-greater th ferritn-43 trf-270 05:34pm blood %hba1c-5.8 07:20am blood heparin dependent antibodies-pnd brief hospital course: 66yo man with a h/o cad s/p cabg and mult pci, as, who underwent cardiac cath on for progressive doe, found to have a new ostial occlusion of svg->d1, not intervened upon because of critical as (0.88cm2). the patient decided to pursue an avr at another time and to proceed with stenting of the svg->d1 lesion. he returned to the cath lab on for pci where he had a cypher stent placed in the svg-d1. right heart cath revealed an elevated pcwp of 26, and his aortic valve gradient was imaged with and without dobutamine and there was no change with dobutamine. he went to the ccu for tailored diuresis with swan-ganz catheter. he received one dose of lasix and put out 1.2l overnight, with pcwp dropping to 13 thereafter. he reported feeling much less short of breath, and was discharged shortly thereafter. . # cad: had cypher stent placed today to svg-diag graft, asymptomatic. continued pt on asa, plavix, statin, ramipril, carvedilol. held imdur. . # pump: lvef 25%, pcwp 26 on right heart cath on -s/p tailored diuresis in ccu, with resolution of volume overload on exam and pcwp normalized -cont lasix at increased dose of 40mg -cont carvedilol 12.5 -cont digoxin 0.125mg daily, which was started on . -consider -v pacer for synchrony long term . # rhythm: history of afib. currently in sinus. --cont bb, amiodarone --cont tele --not on coumadin . # as: pci initially postponed yesterday given worsening of valve area, now 0.88cm2 (1.3 in ) and possibility of avr. however, patient declined surgical intervention at this time and measurement of gradient with dobutamine showed no change indicating no need for avr at this time. monitored volume status closely given pt. is preload dependent. . # cri: baseline 1.5, now improved to 1.2 --continue to monitor . # anemia, borderline microcytic: -low retic count, underproducing -possibly iron def with ferritin low at 43, iron/tibc 20%; started iron to see if improves -no evidence of b12 or folate deficiency on labs. guaiac negative on admission -will check tsh -received one unit of blood 5/24 * # thrombocytopenia: not new, dates back to , unknown etiology - given chance of concommitent hit i or ii, dr. requested hit ab be sent and heparin products be avoided; remained stable while in hosue; pt will need outpatient workup for chronic thrombocytopenia medications on admission: home medications: lopressor 50mg twice a day imdur 60mg daily every morning altace 10mg daily every morning amiodarone 200mg daily every morning hytrin 5mg daily every evening aspirin 81mg daily every morning plavix 75mg daily every morning lipitor 40mg daily every evening lasix 40, one and a half tablets every morning (held on ) kcl 20meq daily every morning (held on ) prilosec 20mg daily every morning discharge medications: 1. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 2. ramipril 5 mg capsule sig: two (2) capsule po daily (daily). 3. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 4. terazosin 5 mg capsule sig: one (1) capsule po hs (at bedtime). 5. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 8. furosemide 80 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 9. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 10. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 12. imdur 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. discharge disposition: home discharge diagnosis: angina aortic stenosis coronary artery disease congestive heart failure discharge condition: good. ambulating without shortness of breath or difficulty. discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1.5l per day take all of your medications as prescribed. call your cardiologist or go to the ed if you experience chest pain, shortness of breath, dizziness, nausea, fever, or any other symptom that is of concern to you. please note the following changes to your medications: started digoxin started carvedilol in place of coreg lasix changed to 40 twice daily followup instructions: please follow up with your cardiologist, dr. , in weeks. please have him evaluate the need for aicd and ep consult, as well as outpatient pet scan or thallium study to assess viability of myocardium. procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters coronary arteriography using two catheters angiocardiography of left heart structures angiocardiography of left heart structures left heart cardiac catheterization pulmonary artery wedge monitoring insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified coronary atherosclerosis of autologous vein bypass graft atrial fibrillation aortic valve disorders other chronic pulmonary heart diseases other specified forms of chronic ischemic heart disease other and unspecified angina pectoris cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other complications due to other cardiac device, implant, and graft iron deficiency anemia, unspecified automatic implantable cardiac defibrillator in situ accidents occurring in other specified places 

Answer: The patient is high likely exposed to