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: amoxicillin attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization with placement of cypher stent in rca history of present illness: mr. is a 53 year-old male with a history of cad (s/p cabg and prior pci to rca) who presented to an osh with chest pain and was transferred to for persistent chest pain. . he was in his usual state of health until 4 days prior to admission. at that time, he went fishing and walked up a large . he experienced chest discomfort, typical for him, while doing this. the pain is "squeezing" and is associated with diaphoresis and nausea. it radiates to his shoulders/arms/neck. at that time there was some associated sob, which is not typical for him. over the next two days, he continued to feel unwell, but the pain had subsided. one day prior to transfer, he experienced "reflux" which he explains is similar to his cardiac chest pain. this persisted with no relief from 2 percocet. he presented to the osh for further care. . blood pressure noted to be 130/70, hr 70 and irregular. initial troponin i (1:15pm) was 0.09 and the subsequent troponin (5:05pm) was 0.13. his serum cr was 2.1. he was started on nitro and heparin gtts. . past medical history: cad history: cabg in after large dissection of mid lad with attempted stent repair -lima-->lad -svg-->om1 -svg-->diag percutaneous coronary intervention: -rca: stented in ; stented with des cath in lmca: normal lad: 100% stenosis lima: patent lcx: small vessel svg-->ramus: patent rca: 80% eccentric distal stenosis svg-->diag: occluded other pmh: 1. diabetes mellitus, on insulin 2. hypertension 3. hyperlipidemia 4. congestive heart failure, systolic dysfunction: ef 35% (echo ) 5. complete heart block, s/p ddd pacer , changed in for complete heart block 6. sternal wound dehiscence s/p muscle flap closure 7. renal cell carcinoma, s/p left nephrectomy 8. gerd 9. chronic pain secondary to disk disease 10. chronic kidney disease 11. osa 12. s/p ccy allergies: pcn social history: social history is significant for the absence of current tobacco use. there is no history of alcohol abuse. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: blood pressure was 140/89 mm hg while seated. pulse was 78 beats/min and regular, respiratory rate was 18 breaths/min and he was satting 98% on 3l nc. generally the patient was morbidly obese. 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 large and it was difficult to assess jvp. there was an obvious sternal incision scar and some chest pain with palpation. 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. . cardiac exam revealed 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. . there was no hepatosplenomegaly or tenderness. the abdomen was soft nontender and nondistended. the extremities had no pallor, cyanosis, clubbing; there was 2+ pitting edema bilaterally. 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. pertinent results: 06:21pm blood wbc-8.0 rbc-4.82 hgb-13.6* hct-38.8* mcv-80* mch-28.3 mchc-35.2* rdw-16.1* plt ct-150 07:10am blood hct-39.8* plt ct-150 07:05am blood pt-13.0 ptt-23.9 inr(pt)-1.1 06:21pm blood glucose-226* urean-32* creat-1.8* na-138 k-4.6 cl-100 hco3-27 angap-16 07:10am blood glucose-215* urean-33* creat-2.0* na-138 k-4.7 cl-100 hco3-28 angap-15 06:21pm blood ck(cpk)-111 10:53pm blood ck(cpk)-99 07:10am blood ck(cpk)-94 06:21pm blood ck-mb-6 ctropnt-0.06* 01:15pm blood ck-mb-5 ctropnt-0.05* 07:10am blood calcium-9.3 phos-3.7 mg-2.3 06:05am blood tsh-1.8 ekg demonstrated a v-paced rhythm with right bundle morphology. there were no obvious st-t changes. . ett performed on demonstrated decreased uptake in teh anterior septal wall with some reuptake, fixed inferior defect, vl dilation and an ef of 34%. . cardiac cath performed on right coronary dominance. the left main was free of disease; the lad showed a known occlusion with a patent lima; ramus was occluded with an open svg; lcx was patent and gave rise to several small marginal branches in the posterolateral branch. it was free of significant disease. the rca showed an 80% focal, high-grade eccentric stenosis. the pd and pl were free of disease. . cardiac cath : the initial angiography revealed an 80% instent restenosis of the previously placed mid rca stent. heparin was administered for anticoagulation. the initial strategy was to direct stent the lesion with a drug eluting stent using minimal amount of contrast given renal insufficiency and using previously placed stent as . jr4 provided an excellent support. choice pt xs wire crossed the lesion relatively easily. 3.0 x 18 mm cypher was deployed at 20 atms and postdilated with 3.5 x 12 mm quantum maverick at 20 atms in the mid and proximal stent. there was no residual stenosis, dissection, embolization or perforation. the patient experience his anginal pain with balloon inflations that resolved with nitroglycerine. 1. three vessel coronary artery disease. patent lima to lad and svg to d1 graft. 2. moderate systolic and diastolic ventricular dysfunction. 3. successful stenting of native mid rca in stent restenosis with cypher des . renal ultrasound : the right kidney measures approximately 11.3 cm in diameter. there is a small, echogenic 9 mm focus within the left pole of the right kidney, appears relatively non-shadowing, but most likely represents a noncalcified stone. no renal masses. hydronephrosis is present. there is good corticomedullary differentiation. brief hospital course: 54 year-old male with history of cad and multiple risk factors, admitted with chest pain that had not resolved. . 1. chest pain: given the high suspicion for acs, the patient was admitted to the ccu and put on heparin and nitro drips, without improvement in his pain. the patient had no ekg changes and his enzymes were negative. it was felt that his chest pain was most likely due to gi problems, and he was given a cocktail with maalox and lidocaine and continued on a ppi and transferred to cardiac stepdown. he continued to have chest pain, and given his established extensive disease, he was sent for cardiac catheterization on . he was found to have instent 80% restenosis in his rca and a cypher stent was placed. given that he described "heartburn" that was sometimes relieved by ppi/gi cocktail, he was advised to follow-up with a gastroenterologist near his home in for possible egd. he was advised to continue his ppi on discharge. . 2. chronic kidney disease: pt had prior nephrectomy for renal cell carcinoma as well as possible medical renal disease from dm and hypertension. his cr on admission was 1.8; his ace inhibitor was held prior to cath, and he received acetylcysteine with fluids prior to his cath. in addition, administration of contrast was minimized during the procedure. his cr was 2.0 on the day following his cath. he was instructed to go home on 5mg enalapril daily rather than . he will have follow-up with his cardiologist, dr. on . at that time, his cr can be checked and his home dose of enalapril can be adjusted. . 3. rhythm: patient has a dual pacer without a defibrillator. he was monitored on telemetry, and had a few episodes of non-sustained ventricular tachycardia, no more than 13-14 beats. his electrolytes were closely watched and repleted as needed. in addition, evaluation of his tracings was notable for two different qrs morphologies. it was felt that the majority of the time, his qrs reflected fusion beats caused by his ventricles being paced just at the time that they were natively firing. to test this theory, the av delay in the pacemaker could be increased to see if his ventricles natively contract. he was advised to follow-up with his outpatient cardiologist for further work-up, and an appointment was made for 1 week after discharge from the hospital. his cardiologist's office was , and his discharge summary and relevant telemetry tracings will be faxed to them. . 4. chf: his home medicines of lasix and ace inhibitor were initially maintained until his enalapril had to be stopped for slight increase in cr. his heart failure was essentially stable during this admission and he did not require diuresis beyond his home regimen. medications on admission: fenofibrate 145mg po daily norvasc 10mg po daily digoxin 250mcg po daily asa 81 po daily plavix 75mg po daily oxycodone 5-10mg po daily lipitor 10mg po daily toprol xl 50mg po daily aciphex 20mg po bid enalapril 5mg po bid furosemide 20mg po bid clarinex 5mg po daily flonase insulin--he describes the type as "u", unclear dose discharge medications: 1. fenofibrate micronized 145 mg tablet sig: one (1) tablet po daily (). 2. amlodipine 10 mg tablet sig: one (1) tablet po once a day. tablet(s) 3. digoxin 250 mcg tablet sig: one (1) tablet po daily (daily). 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 7. lipitor 10 mg tablet sig: one (1) tablet po once a day. 8. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 9. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 10. aciphex 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 11. enalapril maleate 5 mg tablet sig: one (1) tablet po once a day. 12. furosemide 20 mg tablet sig: one (1) tablet po twice a day. 13. clarinex 5 mg tablet sig: one (1) tablet po once a day. 14. flonase 50 mcg/actuation aerosol, spray sig: sprays nasal twice a day as needed for allergy symptoms. discharge disposition: home discharge diagnosis: primary dx: cad secondary dx: dm, htn, systolic chf (ef 35%), cri discharge condition: improved. patient continued to have some chest pain which he described as 'heart burn.' he was not short of breath or diaphoretic. he was eating and drinking well and his vital signs were stable. discharge instructions: you were admitted with chest pain; it was difficult to decide if your pain was due to coronary artery disease or acid reflux in your stomach. a cardiac catheterization was done and a cypher stent was placed in your right coronary artery. 1. please take all your medicines as prescribed. 2. please go to your follow up appointments, listed below. 3. please call your physician or come to the hospital if you have worsening chest pain, worsening shortness of breath, fevers, or any other concerning symptom. 4. please continue your home regimen of insulin. followup instructions: you have an appointment with dr. on at 1pm. please arrange to see a gi doctor for a possible egd (endoscopy). procedure: left heart cardiac catheterization coronary arteriography using a single catheter angiocardiography of right heart structures 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: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortocoronary bypass status chronic kidney disease, unspecified other and unspecified hyperlipidemia long-term (current) use of insulin chronic systolic heart failure other complications due to other cardiac device, implant, and graft cardiac pacemaker in situ personal history of malignant neoplasm of kidney 

Answer: The patient is high likely exposed to