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: demerol / benadryl attending: chief complaint: headache major surgical or invasive procedure: cardiac angiography history of present illness: hpi: is a 61-year-old gentleman with history of htn, iddm, hypercholesterolemia, dvt, who was brought to the ed per ems after he developed vomiting and nausea and was off balance following a headache that he has been having for 6 days. he initially presented to the emergency department on for headache and mental status changes. he was intubated for ? airway protection and admitted to the tsicu, where he was extubated fairly rapidly. initial concern was for a cva, but head ct and mri/mra were unremarkable. while on the floor, patient had several episodes of hypertensive urgency, with systolics reaching 220. cardiology team was consulted, who recommended labetolol with goal sbps 150-160, stress results from , mri and 24 hour urine to eval for pheochromocytoma. . while in the icu he was evaluated with mri/ct/mra which did not show any abnormalities. additionally an lp was done which did not show any signs of infection though was not sent for viral pcr (likely suspicion was low). he was empirically treated with vancomycin, ceftriaxone and acyclovir (vanc, ceftriaxone stopped , acyclovir stopped ). for bp control the patient was on nicardipine, then labetolol and briefly a nitroglycerin drip. he also was given ivf and showed signs of volume overload and was diuresed. past medical history: - htn - iddm - hypercholesterolemia - history of dvt in r-leg - cataract, s/p surgery - headaches, no migraine headaches per wife - rosacea social history: occupation: accountant from to (works 7 days a week during this period; very sedentary) no illicit drugs, occ alcohol, smoking walks without assistance married, 2 children. family history: -dm, htn, breastca mom, no migraine headaches cardiac risk factors: diabetes, dyslipidemia, hypertension physical exam: blood pressure was 175/82 mm hg while seated. pulse was 95 beats/min and regular, respiratory rate was 24 breaths/min. 02 sat 97% 4l t 99.9 generally the patient was well developed, well nourished and well groomed. the patient was oriented to person, place and time. the patient's mood and affect were not inappropriate. . there was no xanthalesma and conjunctiva were pink with no pallor or cyanosis of the oral mucosa. the neck was supple with jvp of 10 cm, though difficult to assess secondary to obesity. the carotid waveform was normal. the were no chest wall deformities, scoliosis or kyphosis. the respirations were not labored and there were no use of accessory muscles. the lungs were clear to ascultation bilaterally with normal breath sounds and no adventitial sounds or rubs. palpation of the heart revealed the pmi to be located in the 5th intercostal space, mid clavicular line. there were no thrills, lifts or palpable s3 or s4. the heart sounds revealed a normal s1 and the s2 was normal. there were no rubs, murmurs, clicks or gallops. the abdominal aorta was not enlarged by palpation. there was no hepatosplenomegaly or tenderness. the abdomen was soft nontender and nondistended. the extremities had no pallor, cyanosis, clubbing or edema. there were no abdominal, femoral or carotid bruits. inspection and/or palpation of skin and subcutaneous tissue showed no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ . skin: erythematous cheeks/nose neuro: perrl, eomi, cn ii-xii intact, strength 5/5 ue, sensation intact ue, decreased secondary to neuropathy or le. alert and oriented x 3. able to remeber building () and do serial 7's without difficulty pertinent results: 03:45pm blood wbc-11.8*# rbc-5.26 hgb-15.6 hct-44.9 mcv-86 mch-29.6 mchc-34.6 rdw-14.2 plt ct-275 07:02am blood wbc-9.0 rbc-4.54* hgb-12.9* hct-39.5* mcv-87 mch-28.4 mchc-32.7 rdw-14.4 plt ct-327 03:45pm blood neuts-83.6* lymphs-10.6* monos-4.4 eos-1.2 baso-0.2 06:10am blood neuts-73.9* lymphs-14.2* monos-7.1 eos-4.3* baso-0.6 07:08am blood pt-12.7 ptt-71.0* inr(pt)-1.1 06:40am blood pt-12.9 ptt-84.2* inr(pt)-1.1 02:20am blood esr-15 12:59pm blood esr-22* 07:02am blood urean-24* creat-1.2 k-4.1 03:45pm blood glucose-152* urean-19 creat-1.1 na-142 k-4.2 cl-103 hco3-27 angap-16 04:20am blood ck(cpk)-1778* 12:11pm blood ck(cpk)-* 12:02am blood ck(cpk)-* 06:40am blood ck(cpk)-136 02:20am blood ck-mb-7 ctropnt-<0.01 04:20am blood ck-mb-23* mb indx-1.3 ctropnt-0.23* 12:11pm blood ck-mb-22* mb indx-1.1 ctropnt-0.33* 06:35am blood ck-mb-5 ctropnt-0.45* 12:35am blood ck-mb-5 ctropnt-0.38* 06:40am blood ck-mb-4 ctropnt-0.23* 03:45pm blood calcium-9.6 phos-2.2* mg-2.0 07:02am blood calcium-8.8 mg-2.3 02:20am blood %hba1c-8.1* -done -done 02:20am blood triglyc-272* hdl-30 chol/hd-5.7 ldlcalc-86 02:20am blood tsh-0.49 03:45pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg . . . . . . . ................................................................ mri head on admission: mri head without contrast: the diffusion-weighted imaging is unremarkable without evidence of acute infarction. there are scattered tiny foci of t2/flair hyperintensity within the subcortical white matter bilaterally, which are non-specific and likely represent chronic small vessel ischemic changes. the signal intensity of the brain parenchyma otherwise throughout is unremarkable. there is no evidence of mass, edema, or shift of normally midline structures. mra of the circle of : the vertebral arteries, basilar artery, and right posterior cerebral artery are well identified. however, there is a sharp cutoff of the p1 segment of the left posterior cerebral artery which is not clearly delineated on the source images. however, there is evidence of artifact on the source images at this level and the apparent cutoff of the artery may be secondary to artifact. the rest of the major tributaries of the circle of are patent. there is no evidence of aneurysm or arteriovenous malformation. impression: 1. no evidence of acute intracranial ischemia. no mass lesions identified. 2. abrupt cutoff of the left posterior cerebral artery, which may be secondary to artifact as there is signal drop out on this level and the source images. however, further evaluation with a repeat mra or ct angiogram is recommended to exclude abnormality involving the left posterior cerebral artery. . . . . . . . ................................................................ non-contrast ct of the head: no acute intracranial hemorrhage, shift of normally midline structures, or major vascular territorial infarct. periventricular hypoattenuation is consistent with chronic microvascular ischemic changes. -white matter differentiation is preserved. the visualized paranasal sinuses and osseous structures are unremarkable. impression: no acute intracranial process. . . . . . . . . ................................................................ mra head : findings: there is fetal origin to the left posterior cerebral artery. the left posterior cerebral artery also appears to take a slightly inferior course from its usual location. there is no evidence of loss of the normal flow signal. the circle of is otherwise normal with no evidence of aneurysms or stenoses. impression: a fetal left posterior cerebral artery with no evidence of loss off the normal flow signal. . . . . . . . . ................................................................ eeg done while with ms changes: impression: this is a mildly abnormal eeg in the primarily sleeping state due to the excessive sleep with a 6 hz background rhythm. this suggests either excessive drowsiness and sleppr or a mild encephalopathy, which may be seen with infections, toxic metabolic abnormalities or medication effect. a repeat eeg with waking state recorded may better differentiate between sleep and a mild encephalopathy. . . . . . . . . ................................................................ bilateral lower extremity ultrasound: compared to . bilateral grayscale and color doppler ultrasound performed of the common femoral, superficial femoral, and popliteal veins. venous structures demonstrate normal compressibility, flow, waveforms, and augmentation without intraluminal thrombus. impression: no evidence of dvt. . . . . . . . . ................................................................ echo: conclusions: the left atrium is mildly dilated. the estimated right atrial pressure is 0-5mmhg. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. there is a small pericardial effusion posterior to the atria. impression: preserved regional/global biventricular systolic function. mild mitral regurgitation. impaired left ventricular relaxation pattern. small loculated pericardial effusion. . . . . . . . . ................................................................ cardiac catherization: comments: 1. selective coronary angiography of this left dominant system revealed two vessel disease. the lmca was free of critical stenoses. the lad was a small vessel with a proximal ulcerated 70% stenosis. the d1 branch was also small with 80% ostial lesion. the lcx was the dominant vessel and free of critical lesions; there was a 40% stenosis at the origin of the lpda. the rca was a small nondominant and occluded at the mid-vessel. 2. non-selective renal angiography revealed bilateral single renal arteries without angiographically apparent lesions. 3. limited resting hemodynamics revealed mildly elevated left sided filling pressures with an lvedp of 15mmhg and moderate systemic arterial hypertension with an aortic sbp of 158mmhg. 4. successful ptca was performed of the d1 with a 2.0 mm balloon. successful ptca and stenting was performed of the proximal lad with a 2.5 mm cypher drug eluting stent. final angiography revealed 10% residual stenosis in the lad, 30% residual stenosis in the d1, no dissection, and normal flow. (see ptca comments) final diagnosis: 1. two vessel coronary artery disease. 2. no angiographic evidence of renal artery stenosis. 3. mild left ventricular diastolic dysfunction. 4. successful ptca of the d1. 5. successful ptca and stenting of the proximal lad with a drug eluting stent. attending physician: , . referring physician: , . cardiology fellow: , m. , attending staff: , a. brief hospital course: patient is a 62 yo man admitted from the ed with severe hypertension and mental status changes. patient was transferred to the icu and was briefly intubated for airway protectioin. while in the neuroicu, the patient was evaluated with mri, mri/a, ct head and lp all of which did not show signs of either infection or acute change to explain mental status changes. however, however he did have very elevated blood pressure and cardiology consultation felt the clinical picture was consistent with hypertensive encephalopathy. with improved blood pressure control, mental status cleared and patient was mentating well on admission to the floor. . while on the inpatient floor issues were: . # hypertension- patient was restarted on his home medications and then increased as needed to maximize metoprolol, losartan. hctz and amlodipine were added and patient's blood pressure was eventually improved to normotensive. (was decreased slowly by approx 30 mmhg/day). patient counselled at time of discharge on necessity of taking all meds and checking blood pressure daily. . # nstemi/cad: initial troponin leak was thought to be secondary to cardiac stress given that the patient has had significantly elevated bps. however, it continued to rise and eventually peaked at .45. given his clinical history of uncontrolled diabetes and hypertension, it was very concerning for cad. therefore, a cardiac catherization was performed that showed 2 vessel disease and had stenting of the proximal lad and the first diagonal artery. additionally the renal artery angiography was normal. . # mental status- was significantly improved from admission. mentating well without difficulty. likely hypertensive encephalopathy given that patient now improved in the setting of negative workup otherwise. . # diabetes- per patient he was on nph and humalog at home given only every 12 hours. he was continued on nph while here and was also started on a humalog qid sliding scale. glucose control improved, but was not optimal. at time of discharge, it became apparent that the patient had not been tightly following his glucose level and a vna was arranged for follow up of his use of nph as well as humalog sliding scale. further management will need to be done as an outpatient. . medications on admission: - insulin humulin n 60 , humalog 30 ? - lipitor 20 mg - cozaar 100mg qd - zoloft 100 mg qd - atenolol 100mg qd discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. sertraline 50 mg tablet sig: two (2) tablet po daily (daily). 3. atorvastatin 20 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*60 tablet(s)* refills:*0* 4. losartan 50 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 5. atenolol 100 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*0* 6. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 7. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 8. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 9. humulin n 100 unit/ml suspension sig: forty (40) subcutaneous twice a day: and increase to your home scale gradually. 10. humalog 100 unit/ml solution sig: per sliding scale subcutaneous four times a day: check your glucose dialy at breakfast, lunch and dinner and at bedtime and use the sliding scale. discharge disposition: home with service facility: vna discharge diagnosis: hypertensive encephalopathy coronary artery disease . diabetes discharge condition: stable discharge instructions: you were admitted with very severe hypertension and trouble thinking as a result. you must take your medications as prescribed and stick to a low salt low sugar diet. . please call your doctor or go to the er if you have any chest pain, shortness of breath, nausea, vomiting, fever, chills, headaches, trouble with your vision. . please take all medications as prescribed. followup instructions: please call dr. and make a follow up appointment in weeks. additionally if you would like to have a pcp in our system, the number to set up the appointment is . . you also have the following appointments: provider: , m.d. date/time: 11:45 provider: , dpm phone: date/time: 1:20 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung left heart cardiac catheterization coronary arteriography using a single catheter insertion of endotracheal tube angiocardiography of right heart structures arteriography of renal arteries 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 two vessels diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin hypertensive encephalopathy 

Answer: The patient is high likely exposed to