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: history of present illness: this 86-year-old female was admitted from hospital after cardiac catheterization on . prior to the angiogram, the patient reportedly had chest pain relieved by sublingual nitroglycerin. she also reported shortness of breath after one block and climbing any stairs. cardiac catheterization showed three-vessel disease. the patient was placed on heparin drip and transferred to . the patient also had a history of transient ischemic attack with no residual and was placed on coumadin prior to her admission. past medical history: hypertension. coronary artery disease. hypothyroidism. atrial fibrillation. history of transient ischemic attack. status post cholecystectomy. status post pacemaker insertion. status post thyroidectomy. status post left total hip replacement, . medications on admission: aspirin, coumadin, lopressor 50 mg p.o. b.i.d., norvasc, prilosec, synthroid 125 mcg p.o. once daily, imdur 90 mg p.o. once daily, zestril 3 mg once daily. physical examination: she was in atrial fibrillation with a heart rate of 85, saturation of 99 percent on three liters nasal cannula, blood pressure 130/70 with a respiratory rate of 16. she was alert and oriented times three but was a fairly poor historian. her lungs were clear bilaterally. heart was irregularly irregular. abdomen was soft, nontender, nondistended. she had two plus bilateral radial pulses, two plus femoral pulse on the left. her right femoral artery had an a-line in place. dorsalis pedis on the left was palpable and on the right was biphasic. laboratory data: cardiac catheterization showed a left main 75 percent lesion, a mid left anterior descending coronary artery lesion of 90 percent and totally occluded right coronary artery and a ramus lesion of 50 percent. preoperative labs are as follows: sodium 142, potassium 3.5, chloride 105, bicarbonate 26, bun 9, creatinine 0.7 with a blood sugar of 110, hematocrit 39.1, ptt 26.9. hospital course: cardiac echocardiogram and carotid ultrasounds were also ordered. the patient did remain on the medical service for a number of issues prior to surgery, which did not take place until . the first issue that had to be addressed was the patient became febrile and white blood cell count rose slightly. the patient was also consulted by the infectious disease service as they looked for a possible source of the fevers. the patient was also followed by the cardiology fellow. her sheaths were pulled as it was determined that she would not be going to surgery right away. the patient was transferred into the coronary care unit after she was seen on admission. she was also started on a nitroglycerin drip. this helped bring her blood pressures down. on arrival, her blood pressure rose to 200/90. nitroglycerin drip helped to improve her blood pressure to the 130s systolic. the patient did not have any chest pain or shortness of breath at the time. she continued in atrial fibrillation and remained on an intravenous heparin drip as well as receiving her beta blocker. she was seen by dr. on who also quoted her significant mortality of approximately 20 percent based on her age and her other relative risk factors. she did remain afebrile on with a normal white count. the plan was to wait until she was afebrile, at least 24 hours. additionally, the patient had some postoperative bleeding from her right groin site and required additional compression to avoid hematoma. heparin was held. the patient had a new bruit over the femoral artery with decreasing blood pressures. prior to the groin bleeding, blood pressures systolic were 160/170 and dropped to 104/51. ct scan was ordered to rule out also a retroperitoneal bleed. the patient was given an intravenous fluid bolus and was followed on the cardiology service and dr. , cardiologist, was also notified. given her fever and her groin bleed, the decision was made to postpone her surgery. the following day, surgery was rescheduled but the patient that night spiked a temperature to 101.2 and surgery was again postponed. the patient was also seen by the oral and maxillofacial surgery service preoperatively to rule out a dental infection. please refer to their consult note. white count did rise on preoperatively to 11.1 and then dropped to 7.4. blood cultures were pending. at that time, we renewed our request that cardiac surgery not be performed on the patient until she remained afebrile for 24 hours with a normal white count. carotid ultrasounds were performed on , which showed a 60-69 percent right internal carotid artery stenosis and a 40-60 percent left internal carotid artery stenosis. please refer to the final report. a dental consult also revealed the patient had a retained root of a tooth which should probably be removed before surgery but it was unlikely to be the source of her fever. their recommendations were followed in terms of specific mouthwash for the patient to use. they recommended the patient follow-up with her dentist or an omfs as an outpatient to have the root removed after surgery. the patient was also seen by the infectious disease consult team who recommended a full body scan for the patient's chest, abdomen and pelvis to look for any sources of her fever. the patient was also tested for tuberculosis. the patient was also followed everyday by dr. of cardiology, her attending cardiologist. fever workup continued on . dental and infectious disease consults were noted and appreciated. h. pylori testing was sent off also. on , the patient's right groin hematoma was approximately walnut sized with occasional droplets of bright red blood oozing. mini pressure dressing continued to be applied with no further bleeding later in the day. the patient was maintained on bedrest at the time and did have pedal pulses. the patient was cleared for surgery on . on , the patient underwent coronary artery bypass grafting times four by dr. with the left internal mammary artery to the left anterior descending coronary artery, a vein graft to the posterior descending coronary artery, a vein graft to the diagonal and vein graft to the ramus. the patient was transferred to the cardiothoracic intensive care unit av paced in stable condition on a neo- synephrine drip at 0.24 mcg/kg/min and propofol drip at 10 mcg/kg/min. prior to surgery, urine cultures, blood cultures and rpr were all negative on the patient. abdominal scans did not reveal anything other than an incidental infrarenal abdominal aortic aneurysm. please refer to the vascular surgery consult. chest ct showed some pulmonary nodules as read by radiology. please refer to the final report. recommendation was made that the patient get outpatient follow-up after discharge post bypass surgery to follow-up on the nodules. the patient was also seen by electrophysiology service to interrogate her pacemaker postoperatively. their impression was that the patient needed a new pacemaker generator before discharge. epicardial pacing wires remained in place. on postoperative day one, the patient remained on an insulin drip at two units per hour. blood pressure 131/49. hemodynamically stable in sinus rhythm at 71. she remained on the ventilator. postoperative labs were as follows: white blood cell count 10.2, hematocrit 28.2, platelet count 160,000, sodium 146, chloride 112, bicarbonate 23, bun 9, creatinine 0.7 with a blood sugar of 75. the patient continued on perioperative antibiotics. the patient was also seen by the case management team. after extubation on , it was noted that the patient's baseline speech was slightly garbled at times. the patient was oriented though and following all commands and moving all four extremities. the patient was in atrial flutter with the pacer responding appropriately and periods of normal sinus rhythm. beta blockage was restarted with lopressor. the patient's saturation was 95-98 percent on three liters nasal cannula. her lungs were clear. chest tubes remained in place. on postoperative day two, the patient received two units of packed red blood cells which brought her hematocrit up to 31. her heart was regular in rate and rhythm. her chest tubes remained in place. she had decreased breath sounds bilaterally. she had one plus peripheral edema. her incisions were unremarkable. she was back in atrial fibrillation. the patient was restarted on her coumadin of 3 mg dose that evening and started on captopril. chest tubes were pulled. lasix diuresis was begun and the patient was transferred out to the floor. on postoperative day three, pacing wires had also been discontinued. the patient continued on coumadin 3 mg dose that evening. hematocrit rose slightly to 33.2. captopril was increased to 6.25 twice a day. creatinine remained stable at 0.8 with a potassium of 3.7. the patient remained v-paced under her own pacemaker at 68. incisions were clean, dry and intact. she had a trace of pedal edema. she was seen again by the electrophysiology service on and recommended keeping the patient npo that day so that she could have her generator changed the following morning as soon as she received infectious disease clearance. she also continued to work with the physical therapist. occasionally, the patient was slightly confused to time of day, asking some odd questions. she was also noted to be very hard of hearing. she continued in atrial flutter with underlying occasional runs of supraventricular tachycardia. electrolytes were all repleted as needed. on , the patient was taken back to the catheterization laboratory for a pacemaker generator change by the electrophysiology service and dr. . the following day, the patient was transferred out of the cardiothoracic intensive care unit. the patient was a little bit confused and trying to get up. a sitter was requested for the patient. exam was unremarkable. incisions were clean, dry and intact. the patient had no complaints of pain at that time. on postoperative day six, the patient continued to have a little bit of confusion and restlessness the evening prior after her pacemaker change. this did require a sitter. she was much clearer in the morning. she continued on vancomycin perioperative antibiotics additionally to cover her pacemaker change. she had decreased breath sounds bilaterally. she had a nonfocal exam. extremities were warm with one plus peripheral edema. incisions were clean, dry and intact. the patient was encouraged to be more mobile with physical therapy but was stable. her foley was removed and she continued on her coumadin dosing for atrial fibrillation. she continued to work with the physical therapist. it was determined the patient would probably require discharge to rehabilitation as she was still requiring a sitter one to one. the patient needed to be oriented appropriately p.r.n. on , the patient had a five-beat run of ventricular tachycardia which resolved spontaneously. the following day, the patient was much more alert and oriented. the one to one sitter was discontinued. she had no confusion noted and was responding appropriately. on postoperative day five, discharge planning was begun and rehabilitation screens were also accomplished to allow the patient to go to an outside facility, to continue work with physical therapy and her general overall strength given her age. the patient continued to make rapid improvement and the plan was then changed to allow her for the possibility of going home on with the possibility of vna services. the patient's sister had agreed to stay with the patient during the day but was unclear as to who was going to stay with the patient at night but to make sure that the patient was safe in the evenings this was all re-evaluated by the case manager. on postoperative day six, the patient was back in sinus rhythm with occasionally v-paced beats, blood pressure of 140/68, hemodynamically stable. she had some scattered rhonchi bilaterally and her plan for discharge was again delayed as her inr only rose to 1.9, well below therapeutic range. on postoperative day eight, we continued to await the rise in her inr. her exam was unremarkable and she was remaining hemodynamically stable with saturation of 97 percent on room air. she continued to progress and was using her rolling walker without any difficulty. she was moving out of bed and getting out of bed to bathroom by herself, also without any difficulty. the patient was discharge to home on with instructions for the vna to draw blood for inr levels and to call the results to the patient's primary care physician. patient was also instructed to follow-up with her local cardiologist, dr. , in approximately 7-10 days after discharge; to follow-up with her primary care physician, . , for an appointment in days post discharge but dr. is also responsible for following the patient's coumadin dosing and inr, phone number . the patient was also instructed to follow-up with dr. , her surgeon, in the office in approximately three weeks post discharge for her postoperative surgical visit. in addition, an appointment had been scheduled at the center cardiac services for pacemaker device check at the clinic on and to come to 2 for her wound check on . discharge diagnoses: status post coronary artery bypass grafting times four. atrial fibrillation. history of transient ischemic attack. hypertension. hypothyroidism. status post pacemaker generator change. status post cholecystectomy. status post thyroidectomy. discharge medications: 1. enteric coated aspirin 81 mg p.o. once daily. 2. colace 100 mg p.o. twice daily. 3. lasix 20 mg p.o. once daily for five days. 4. metoprolol 50 mg p.o. twice daily. 5. captopril 12.5 mg p.o. three times daily. 6. synthroid 112 mcg p.o. once daily. 7. pravachol 10 mg p.o. once daily. 8. potassium chloride 20 meq p.o. once daily for five days. 9. this evening's dose of coumadin, 1 mg for the evening of discharge, 1 mg for post discharge day one on and , then inr check and call results to dr. for additional coumadin dosing. disposition: the patient was discharged to home with vna services in stable condition on . , m.d. procedure: (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery monitoring of cardiac output by other technique transfusion of packed cells transfusion of other serum replacement of any type pacemaker device with single-chamber device, not specified as rate responsive diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome pure hypercholesterolemia unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation long-term (current) use of anticoagulants fitting and adjustment of cardiac pacemaker dissection of aorta, abdominal retained dental root 

Answer: The patient is high likely exposed to